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Amlodipine pinpoint rash12/30/2023 ![]() 1Īmlodipine works by blocking the calcium ion channels and inhibiting the actin-myosin complex and cardiac muscle contraction. 1, 2 In rare cases, these reactions present as a CD30 + lymphocytic infiltrate that resembles clinical and histologic variants of cutaneous T-cell lymphoma. Drug-induced reactions usually appear within weeks or months of administration of the offending drug and resolve within 2 months of withdrawal. A clonal rearrangement of the T-cell receptor γ gene was detected by polymerase chain reaction in the skin.Ĭutaneous drug hypersensitivity reactions account for roughly 3% of hospitalizations, 1 although this finding may be an underestimation because of variability in the presentation, identification, and reporting of drug-induced cutaneous rashes. The pathology-based differential diagnoses included lymphomatoid papulosis, lymphomatoid drug reaction, and less likely CD30 +-transformed mycosis fungoides. CD30 highlighted a portion of the epidermotropic infiltrate ( Fig 3). Immunostaining found that the large atypical cells were strongly CD30 + and weakly CD3 +. Spongiosis of the overlying epidermis was noted with subcorneal collections of neutrophils along with subtle epidermotropism ( Fig 2). T-cell receptor γ assay of the blood was positive for a polyclonal T-cell receptor γ gene rearrangement.Ī biopsy of the right thigh found superficial perivascular and interstitial dermatitis with atypical lymphocytes. Whole-body positron emission tomography–computed tomography found a mildly hypermetabolic subcentimeter left cervical level Ib lymph node with standardized uptake value of a maximum of 1.69. Flow cytometric analysis of peripheral blood showed a slightly elevated CD4/CD8 ratio of 5.4 but otherwise did not show an immunophenotypically abnormal cell population. Her chronic myelogenous leukemia has been in remission for the last 24 years after transplant and requires no medication. The patient was taking metformin for diabetes. The patient's medical history was significant for graft-versus-host disease (GVHD) 24 years prior after a bone marrow transplant for chronic myelogenous leukemia, diabetes, and amlodipine-associated flushing and ankle edema. doi:10.Pruritic erythematous scaly papules coalescing into plaques on the patient's dorsal right thigh. ![]() Ranmuthu CKI, Hall PN, Funston G, Walter FM. The role of inflammation in the pathology of acne. Therapeutic plasma exchange in renal disorders. ![]() doi:10.1056/nejmcp1103641įairview Patient Education Petichiae (child). Diagnosis and treatment of lichen planus. Tracz ES, Al-jubury A, Buchmann K, Bygum A. Purpuric and petechial rashes in adults and children: initial assessment. Pityriasis rosea: diagnosis and treatment. Diagnosis and management of pityriasis rosea. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. British Association of Dermatologists' guidelines for the management of contact dermatitis 2017. ![]() Johnston GA, Exton LS, Mohd Mustapa MF, et al. Heat rash, sun rash-what's the difference?.Īmerican Osteopathic College of Dermatology. ![]() Does your child have a heat rash? Cool it down-here's how. Journal of the American Academy of Dermatology. Disparities in dermatology educational resources. How to treat acne in skin of color.Įbede T, Papier A. ![]()
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