Rashes that mimic tcel lymphoma skin#
Differential diagnoses of the rash shown in Figure 1 7 ConditionĬhronic skin condition consisting of an annular papular rash,usually affecting the posterior surface of the arms, hands or feet Answer 2ĭifferential diagnoses are outlined in Table 2. Answer 1Ī cutaneous T-cell lymphoma needs to be considered and ruled out in any skin rash initially thought to be benign that is refractory to treatment or progresses. Posttreatment there was no further evidence of disease activity. He completed 4 weeks of rotational electron irradiation. The patient was commenced on oral methotrexate 40 mg weekly, a daily topical steroid application and daily wound dressings. What is the management of this condition? Case study continued These findings are consistent with a peripheral T-cell lymphoma On immunofluorescence, these lymphocytes are positive for T-cell marker CD2 and CD3, CD4: CD8 ratio >1 and <1% CD30 positive cells. The dermis contains heavy interstitial lymphocytic and histiocytic infiltrate with atypical lymphocytes present. Histopathological report of a punch biopsy of the patient's rash Histopathological examination of lesional skin biopsies shows epidermal spongiosis and lymphocyte exocytosis. A computed tomography (CT) scan showed only a single enlarged right inguinal lymph node, measuring 2.2 cm in diameter.
Rashes that mimic tcel lymphoma full#
Other blood tests, including full blood examination (FBE), were normal. Immunoglobulin E was raised at 1681 kU/L. The patient's histopathological report of a punch biopsy of the rash is shown in Table 1. What diagnosis explains the clinical picture described above? Case study continued What initial investigations would you perform in this case? Question 4 What differential diagnoses would you consider for the rash shown in Figure 1? Question 3 What diagnosis must be considered and excluded? Question 2 Lesions on the patient's trunk Question 1 Constitutional symptoms remained absent.įigure 1. He had a single palpable right inguinal node. The annular lesions were around 2–3 cm in diameter with central ulceration and exudate and appeared on top of the pre-existing erythematous scaly lesions (Figure 1).
Other lesions gradually progressed to form annular lesions overlying these scaly patches. Some of these lesions measured up to 30 cm in diameter. Over recent months the lesions had progressed, developing first into variable sized, erythematous, pruritic and scaly patches over his thigh, trunk and back. He had not had any laboratory or radiographic testing. The rash was managed at different times as eczema and psoriasis, however, there was only ever a partial response to steroids. He stated that the rash started with crops of raised, itchy, nonscaly reddybrown lesions, which would ulcerate and then regress over a 6 week period. A man, 69 years of age, who previously had worked in the petroleum industry, presented with a 20 year history of an episodic rash on his arms, legs and trunk.
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