Cefuroxime induced lymphomatoid hypersensitivity reaction

An 84 year old women developed erythematous blotchy erythema and purpuric r ashes over the lower limbs three days after being started on intravenous ce furoxime for acute diverticulitis. A skin biopsy specimen showed a mixed in filtrate of lymphoid cells and eosinophils; many of the lymphocytes were la rge, pleomorphic, and showed a raised mitotic rate. Immunohistochemistry sh owed the infiltrate to be T cell rich, with all the large cells being CD30 positive. Typical mycosis fungoides cells, marked epidermotropism, and Paut rier's abscesses were not seen. The rash disappeared 10 days after cessatio n of cefuroxime and the patient remained asymptomatic 15 months later. This apparent cutaneous T cell lymphoma-like reaction is best described as lymp homatoid vascular reaction. The drug induced immune response with an atypic al cutaneous lymphoid infiltrate mimics a cutaneous pseudolymphoma.