Eosinophilic folliculitis occurring in a patient affected by Hodgkin lymphoma

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A 25-year-old female had a 4-month history of bilateral cervical lymphoadenopathies, weight loss, mild fever, and severe pruritus. A few months earlier, allergological analysis had been performed which revealed raised IgE (4.6 kU/L) against fungi antigens. A right cervical node biopsy led to histological diagnosis of nodular sclerosis-type Hodgkin lymphoma. Clinical symptoms, bilateral cervical lymphoadenopathies, and a large mediastinal involvement (revealed by chest X-ray and thoracic TC) were characteristic of stage IIB (bulky disease). The patient was treated with adriblastine, bleomycin, vinblastine, dacarbazine polychemotherapy (ABVD). Immediately after the administration of this cycle, she developed slightly erythematous, follicular, itchy papules and pustules, localized on her scalp (Fig. 1), trunk (Fig. 2), and thighs. A biopsy from the scalp was obtained under local anesthesia, after patient's consent. Histopathologic findings were characterized by a superficial and deep, dense perifollicular and interstitial infiltrate composed mainly of eosinophils, accompanied by few neutrophils and lymphocytes. Eosinophilic folliculitis involved the whole follicle (inferior segment, isthmus and infundibulum), and also the sebaceous gland (Fig. 3). PAS revealed the presence of some spores of Pityrosporum on the epidermis and also in the follicle. Gram stains proved negative. Eosinophilic folliculitis in an immunocompromised patient was diagnosed. Laboratory findings ascertained that the eosinophil count was in the normal range (eosinophils: 1%; white blood cell count: 10 700/mm3). The lesions healed spontaneously in about 10 days. After a second cycle of polychemotherapy (without dacarbazine, because the patient suffered repeated vascular injection injuries due to this chemotherapeutic agent), new crops of lesions in the same areas developed and in a few days faded away spontaneously. The blood clotting analysis performed just before this new cycle of ABV therapy revealed an eosinophil count of 10%, with a white blood cell count of 4500 mm3. Radiotherapy and four additional cycles of ABV polychemotherapy were made; in the meanwhile, the patient did not develop cutaneous lesions. Actually she is free from Hodgkin lymphoma and from eosinophilic folliculitis.

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