Eosinophilia and Cutaneous Involvement in Angioimmunoblastic T-Cell Lymphoma
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Nan Chen, Internal Medicine Resident, Saul Amber, MD

Angioimmunoblastic T-cell lymphoma (AITL) is a rare, aggressive form of peripheral T-cell lymphoma.  Symptoms of AITL include high fever, night sweats, skin rash, and autoimmune disorders.  We present a rare case of AITL with elevated eosinophil and cutaneous involvement mimicking drug reaction with eosinophilia and systemic symptoms (DRESS)


A 47 year old male patient was referred to Allergists for recurrent pruritic rash, fever, Leukocytosis, eosinophilia, lymphadenopathy.   Rash was proceeded by fever and sweats and then developed pruritis over whole body along with focal skin lesions.   Pt was admitted into hospital with fever of 102.6, WBC 19.1 K/ul, 56% eosinophils, lymphadenopathy, and presumably diagnoses of drug reaction with eosinophilia and systemic symptoms (DRESS).  


Hematology consult and workup was conducted.  Peripheral blood smear showed normocytic anemia, eosinophilia, circulating plasma cell and rouleaux formation .  Right inguinal lymph node biopsy and flow cytometry findings raised the possibility of AITL.  Immunohistochemical stains also demonstrated the feature of AITL, including abnormal lymphocyte to be positive for CD 45, CD3, CD5, CD8, CD4 (loss ), CD7(loss), CD10 (partly), PD1, and in situ hybridization for EBV was positive.  Bone marrow revealed minimal marrow involvement by angioimmunoblastic T-cell Lymphoma, hypermacytosis with marked polyclonal plasmacytosis and moderate eosinophilia.  The patient was subsequently treated with chemotherapy for AITL.


Some patients with AITL experience a nonspecific dermatitis and eosinophilia, who might be referred to Allergists.  Awareness of the presentations of AITL is important for allergists to reach an accurate diagnosis.