NCJ Number
187187
Journal
Journal of Forensic Sciences Volume: 46 Issue: 1 Dated: January 2001 Pages: 156-159
Date Published
January 2001
Length
4 pages
Annotation
This paper reviews the literature on florid, systemic immunoblastic and plasma cell infiltrate, a rare condition of uncertain etiology, and discusses the clinical and pathologic findings in the case of a patient being treated for what was clinically thought to be a drug reaction.
Abstract
Immunoblasts are medium or large transformed lymphoid cells with immunologic features of B or T lymphocytes. The T immunoblasts give rise to T lymphocytes, and B immunoblasts are precursors of plasma cells or memory B cells. Immunoblasts are actively proliferating cells that are normally found in lymphoid tissue. A reactive, non-neoplastic plasmacytic-immunoblastic infiltrate can occur in the lymph nodes of patients with several different disorders, including viral lymphadenitis, drug-related lymphadenopathy, non-viral infections, infectious mononucleosis, autoimmune diseases, and angioimmunoblastic lymphadenopathy. In the clinical case reviewed in this paper, a 43-year-old woman who was receiving oral antibiotics for several days for a superficial foot infection developed a persistent rash, fever, and lymphadenopathy, despite discontinuation of the antibiotic and administration of steroids for a presumed drug reaction. Hours after a subsequent visit to the emergency room for worsening symptoms, she died at home. An autopsy found a florid, systemic proliferation of polyclonal plasma cells and immunoblasts infiltrating nearly every organ and tissue of the body, most notably the lymph nodes and spleen. The polyclonal nature of the process was confirmed by immunofixation electrophoresis and immunohistochemistry. Cases of fatal polyclonal systemic immunoblast proliferations are extremely rare, and the trigger for such proliferations is not always known. The distinction between benign, premalignant, and malignant lymphoid processes is difficult. Increased numbers of plasma cells and immunoblasts in the blood, bone marrow, and lymph nodes, with immunohistochemical and laboratory data indicating a polyclonal process, should allow the correct diagnosis to be made. 4 figures and 7 references