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CASE REPORT
Year : 2009  |  Volume : 30  |  Issue : 2  |  Page : 103-105
 

Dermatopathic lymphadenitis in HIV


1 Department of Pathology, JSS Medical College, Mysore, India
2 Department of Pathology, Tata Memorial Hospital, Mumbai, India

Date of Web Publication24-Apr-2010

Correspondence Address:
H R Vanisri
59/D5, 2nd Main, 2nd Cross, Yadavgiri, Mysore - 570 020
India
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DOI: 10.4103/0253-7184.62767

PMID: 21938130

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   Abstract 

Dermatopathic lymphadenitis is a rare entity described in patients with Human immunodeficiency virus infection. Here we present a case of dermatopathic lymphadenitis in a 50-year-old female who was HIV positive and did not have any obvious skin lesions. Fine needle aspiration cytology of the lymphnode showed a lymphoproliferative lesion and a subsequent biopsy showed atypical lymphoid proliferation showing prominent T-zone. Immunohistochemistry showed features of dermatopathic lymphadenitis.


Keywords: Dermatopathic lymphadenitis, follicular dendritic cells, human immunodeficiency virus, immunohistochemistry


How to cite this article:
Vanisri H R, Nandini N M, Gujral S, Manjunath G V. Dermatopathic lymphadenitis in HIV. Indian J Sex Transm Dis 2009;30:103-5

How to cite this URL:
Vanisri H R, Nandini N M, Gujral S, Manjunath G V. Dermatopathic lymphadenitis in HIV. Indian J Sex Transm Dis [serial online] 2009 [cited 2014 Nov 23];30:103-5. Available from: http://www.ijstd.org/text.asp?2009/30/2/103/62767



   Introduction Top


Dermathopathic lymphadenitis is a well-described histopathological entity characterized by expansion of subcortical zone by dendritic histocytoid cells. [1] Dermatopathic lymphadenitis represents a benign form of reactive lymph node hyperplasia. [2] The relationship between lymph node hyperplasia and cutaneous disease was first described by Pantrier and Woringer as lipomelanotic reticulosis. Subsequent investigators also have described patients with dermatitis and lymphadenopathy. [3],[4] The name dermatopathic lymphadenitis was coined by Hurwitt. [5] Dermatophatic lymphadenitis is often seen in patients with mycosis fungoides and sezary syndrome, but has rarely been described in the absence of clinical skin disease. [6],[7],[8]


   Case Report Top


A 53-year-old female presented with history of fever and gastroenteritis of seven days duration. On examination, she had generalized lymphadenopathy with enlarged cervical, axillary, and inguinal group of lymph nodes. There were no organomegaly. Hematological investigations revealed hemoglobin 8 g%, total leukocyte count 4000 cells/cmm, differential count of 40% neutrophils and 60% lymphocytes. Stool and ultrasound examination of abdomen was normal. ELISA for retrovirus was positive and CD4 cell count was 144 cells/cmm. She did not have any obvious skin lesions.

Fine needle aspiration cytology (FNAC) of cervical group of lymph nodes showed lymphocytes, plasma cells, neutrophils, eosinophils along with histocytoid cells [Figure 1]. A lymph node biopsy showed atypical lymphoid proliferation with prominent T-zone and pigment laden histiocytes. Mixed inflammatory infiltrate was seen comprising plasma cells and immunoblasts. Reedsternberg cells and granulomas were not noted [Figure 2].

Immunohistochemistry tests (CD20, CD43, CD3, CD138) substantiated the benign nature of the lymph node. CD23 was done to highlight follicular dendritic cells (FDC), that occur outside the normal follicles. The FDCs get highlighted depicting the normal follicular frame work of the lymph node. Thus dermatopathic lymphadenitis was considered as the diagnosis [Figure 3].


   Discussion Top


Dermatopathic lymphadenitis is a rare entity described in patients with HIV-1 infection. This patient was retroviral positive without any skin lesions. Dermatopathic lymphadenitis has been described in patients without concomitant skin disease in earlier studies also. [6],[7],[8],[9],[10]

FNAC of cervical lymphnode yielded material which showed mixed population of cells comprising lymphocytes, plasma cells, neutrophils, and eosinophils along with histocytoid cells. Melanin-laden histiocytes were not noted as reported in the earlier studies. [1],[11] Therefore, a diagnosis of lymphoproliferative lesion was considered.

The lymph node biopsy showed atypical lymphoid proliferation showing prominent T-zone with pigment-laden histiocytes. Mixed inflammatory infiltrate was seen comprising plasma cells and immunoblasts. Reedsternberg cells and granulomas were not seen. However, immunohistochemistry results substantiated the benign nature of the node.

Ree and Fanger in their study described a nodular alteration in the paracortical region of the lymph node, which they termed as T nodule. They found this expansion in 58% of axillary lymph nodes from radical mastectomy specimens. They also found it in cervical and inguinal lymph nodes but rarely in abdominal, mediastinal, and retroperitoneal nodes and suggested that the T nodule may involve into a dermatopathic lymphadenopathy like picture. [12] Similar finding was seen in our case and in the earlier study. [9]

Dendritic cells are a normal constituent of lymphnode paracortex and they proliferate in large numbers in dermatopathic lymphadenopathy. These cells are related phenotypically to interdigitating cells of skin and are of langerhan cell lineage. The dendritic cells are thought to present antigen to immunocompetent T cells. [13] Perhaps patients with acquired immune deficiency syndrome (AIDS) are more likely to develop dermatopathic changes due to wide variety of transient and insignificant skin problems. It is known that the number of langerhans cells in the epidermis is decreased in AIDS patients. This decrease may be due to migration of cells from epidermis to the paracortical region of the lymph node and this may account for the dermatopathic changes seen histologically. [10]

We conclude that dermatopathic lymphadenitis can exist in patients with no evidence of skin lesions.

Dermatopathic lymphadenitis though a rare association with HIV infection can still be a possibility in patients with prominent T zone and pigment-laden histiocytes. Immunohistochemistry should be considered for a definitive diagnosis as FNAC and biopsy can be inconclusive.

 
   References Top

1.Sudilovsky D, Cha I. Fine needle aspiration cytology of dermatopathic lymphadenitis. Acta Cytol 1998;42:1341-6.   Back to cited text no. 1  [PUBMED]    
2.Psarommatis I, Vontas H, Gkoulioni V, et al. Dermatopathic lymphadenitis imitating a deep neck space infection. Am J Otolaryngol 2009;30:419-22.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Laipply TC. Lipomelanotic reticular hyperplasia of Lymphnodes. Arch Intern Med 1948;81:19-36.  Back to cited text no. 3      
4.Soloff LA. lipomelanotic reticular hyperplasia of lymphnodes: Report of a case. J Lab Clin Med 1941;27:343-6.  Back to cited text no. 4      
5.Hurwitt E. Dermatopathic lymphadenitis: Focal granulomatous lymphadenitis associated with chronic generalized skin disorder. J Invest dermatol 1942;5:197-204.  Back to cited text no. 5      
6.Auger C, Grandbois J, Gaumond E. Dermatopathic lipomelonotic reticular cell hyperplasia of lymphnodes. Can Med Assoc J 1952;66:245-8.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Herrera GA. light microscopic, S100 immunostaining and ultrastructural analysis of dermatopathic lymphadenopathy, with and without associated mycosis fungoides. Am J Clin Pathol 1987;87:187-95.  Back to cited text no. 7  [PUBMED]    
8.Burke JS, Colby TV. Dermatopathic lymphadenopathy: Comparision of cases associated and unassociated with mycosis fungoides. Am J Cli Pathol 1981;5:343-52.  Back to cited text no. 8      
9.Gould E, Porto R, Albores-Saavedra J, Ibe MJ. Dermatopathic lymphadenitis: The spectrum and significance of its morphologic features. Arch Pathol Lab Med 1988;112:1145-50.  Back to cited text no. 9  [PUBMED]    
10.Burns BF, Wood GS, Dorfman RF. The varied histopathology of lymphadenopathy in homosexual men. Am J Surg Pathol 1985;9:287-97.  Back to cited text no. 10  [PUBMED]    
11.Iyer VK, Kapila K, Verma K. Fine needle aspiration cytology of dermatophatic lymphadenitis. Acta Cytol 1998;42:1347-51.  Back to cited text no. 11  [PUBMED]    
12.Ree H, Fanger H. Paracortical alteration in lymphadenopathic and tumor draining lymphnodes: Histological study. Hum Pathol 1975;6:363-72.  Back to cited text no. 12  [PUBMED]    
13.Kaplan MH, Hall WW, Susin M et al. Syndrome of severe skin disease, eosinophilia and dermatophatic lymphadenopathy in patients with HTLV-11 Complicating human immunodeficiency virus infection. Am J Med 1991;91:300-7.  Back to cited text no. 13      


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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    Abstract
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    Case Report
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