Differentiation of angioimmunoblastic T-cell lymphoma from DRESS syndrome

According to the WHO-UMC classification, 2 and 15 cases were categorized as “certain” and “probable,” respectively. [...]patients with AITL may be susceptible to infection due to immune dysregulation9; this might explain the septic complications in our patients. [...]earlier diagnosis is required in patients with DRESS syndrome–mimicking AITL. [...]whether or not earlier diagnosis affects AITL prognosis is unknown because the rarity of AITL might limit studies on prognostic factors.Online Repository Case 1 Case 2 Case 3 Case 4 Case 5 Age (y) 81 71 70 57 69 Sex Male Female Male Male Male RegiSCAR score 5 4 4 5 6 Suspected drug Ceftizoxime Levofloxacin Cefaclor Gemifloxacin Pneumo-23 Naranjo score 2 2 2 2 1 WHO-UMC category Possible Possible Possible Possible Possible Latent period (d)∗ 12 3 5 5 3 Body temperature (°C) 40.0 38.4 40.0 39.0 39.4 Blood eosinophils, % (/μL) 30.6 (4200) 0.9 (80) 4.3 (1300) 38.9 (6400) 17.7 (3910) Atypical lymphocytes (%) 7 0 0 1 8 Lymphadenopathy Neck on palpation Neck on CT Neck, chest, and abdomen on CT Neck and chest on CT Neck, chest, and abdomen on CT AST (U/L) 19 58 62 30 37 ALT (U/L) 16 18 68 27 93 Creatinine (mg/dL) 1.3 1.6 0.7 1.4 1.4 Survival time (d)† 542 12 19 244 16 Table I Characteristics of the 5 patients with angioimmunoblastic T-cell lymphoma Data Angioimmunoblastic T-cell lymphoma (n = 5) DRESS syndrome (n = 17) Naranjo score∗ 2 (1-2) 6 (5-8) Latent period (d)† 5 (3-12) 24 (4-135) CRP (mg/dL) 6.5 (0.7-19.1) 5.4 (0.1-16.6) ESR (mm/h) 19.5 (2-34) 15.5 (2-52) (n = 16) Leukocytes (×103/μL) 16.5 (9-22.1) 14.3 (5.1-44.6) Lymphocytes (×103/μL) 2.5 (1-6.1) 4.2 (0.6-24.5) Eosinophils (×103/μL) 3.9 (0.08-6.4) 0.7 (0-5.2) Atypical lymphocytes (%) 1 (0-8) 2 (0-34) Hemoglobin (g/dL) 11.6 (10.0-13.8) 11.7 (10.0-14.4) Platelets (×103/μL) 103 (54-332) 188 (84-327) AST (U/L) 37 (19-62) 100 (21-470) ALT (U/L) 27 (16-93) 183 (6-670) Total bilirubin (mg/dL) 1.6 (0.6-1.8) 0.8 (0.5-10.0) BUN (mg/dL) 17.8 (9.6-54.0) 11.1 (4.6-65.5) Creatinine (mg/dL) 1.4 (0.7-1.6) 0.8 (0.3-1.9) LDH (U/L) 875 (506-2,346) 1,115 (609-5,000) β2-Microglobulin (μg/L) 6,152 (4,320-13,621) (n = 4) 5,338 (2,450-11,700) (n = 8) Ferritin (ng/mL) 2,054 (636-2,417) (n = 4) 779 (57-13,612) Table II Comparison of clinical and laboratory data between angioimmunoblastic T-cell lymphoma and DRESS syndrome cases CT findings Angioimmunoblastic T-cell lymphoma (n = 5) DRESS syndrome (n = 17) Lymphadenopathy Maximal LN width (cm) Neck 1.0 (1-1.6) (n = 4) 0.9 (0.5-1.5) (n =