Case Number : Case 2306 - 16 April 2019 Posted By: Uma Sundram

I see some atypical mononuclear cells in the superficial dermis and intravacular spaces (see pict. 2). Immunostains are necessary. The epidermotropism may be part of Sezary syndrome.

Interface dermatitis with eosinophils, so far favor a drug reaction. I understand IgorSC's concern, but I couldn't appreciate cerebriform nuclei on the high power photo, therefore doubt its MF or Sezary.

interface reaction  with eosinophils and LFT elevated

HCV status

also if there is any therapy

eruption of lymphocyte recovery can have atypical lymphocytes mimicking lymphoma but with eosinophils difficult to differentiate from drug rash, did she have any transplant, early GVHR can have elevated LFT and ELR

I favor Drug reaction, and in the context of elevated LFT, I would think in DRESS.

Necrotic keratinocytes and perivascular lymphocytic infiltrate with a few eosinophils suggest a drug hypersensitivity reaction

Agree with a drug reaction( DRESS as Alex said). 

I agree that drug reaction is the best diagnosis, particularly DRESS. Nice.

I agree with drug rash particularly DRESS in view of elevated LFTs

Drug reaction, DRESS in particular

DRESS (drug reaction with eosinophilia and systemic symptoms). The clinician was concerned about this diagnosis. I also emphasize in these cases, that the infiltrate can have a 'pseudolymphomatous' pattern, mimicking MF, particularly follicular MF.