A typical case of Sezary syndrome mimicking an eczema.
An 87-year-old woman was admitted with buccal pain that had started a few weeks before. She had been treated with topical steroids and antihistamines for an undetermined skin disease characterised by generalized erythroderma associated with pruritus for years. Her total white cell count was 13,290/mm3 with 19 % Sezary cells among the lymphocytes. Skin biopsy showed an infiltrate of inflammatory cells forming a dense band below the epidermis characterised by the presence of atypical lymphoid cells with large convoluted nuclei, and significant epidermotropism. Immunophenotyping studies in peripheral blood identified a large increase in CD4+ cells; CD7- T cells. Clonal T- cell receptor gamma gene rearrangement was detected on skin biopsy and bone marrow and on the skin biopsy with the PCR method. This case illustrates the misleading skin presentation of the Sezary syndrome in the elderly.
Internal Medicine Department, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Belgique. hasena75@hotmail.com
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Akouaouach
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Mortaki
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Pepersack
D000368:Aged; D003937:Diagnosis, Differential; D004485:Eczema / Q000175:diagnosis*; D005260:Female; D006801:Humans; D012751:Sezary Syndrome / Q000175:diagnosis*; D012878:Skin Neoplasms / Q000175:diagnosis*