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
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
] 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.