title: Granuloma annulare-like skin lesions as an initial manifestation in a Japanese patient with adult T-cell leukemia/lymphoma.
abstract: Granuloma annulare is characterized by noncaseating dermal granulomas with connective tissue changes. A relationship with hematologic and solid malignancies has been suggested in some cases. We describe a 70-year-old man who had erythematous annular plaques on his elbows, upper extremities, and wrists for a period of 3 months. Histologic examination revealed epithelioid cell granulomas associated with dense atypical lymphocytes in the dermis. Immunohistochemical staining of skin specimens showed a prominent infiltration of CD3+, CD4+, CD5+, and CD25+ cells. Human T-cell leukemia virus type I proviral DNA was detected in the blood and cerebrospinal fluid by Southern blot analysis and polymerase chain reaction assay. The patient was given the diagnosis of adult T-cell leukemia/lymphoma based on the initial cutaneous manifestations. His condition progressed rapidly and led to his death. The granuloma annulare-like skin lesions in our patient could be considered as a peculiar immunologic hypersensitivity reaction of the host against the tumor cells or persistent human T-cell leukemia virus type I viral antigens. Dermatologists should be aware that this skin condition may be an initial manifestation of adult T-cell leukemia/lymphoma.
authors.affiliation: Department of Dermatology, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan. tami@marianna-u.ac.jp
authors.forename: Tamihiro
authors.initials: T
authors.lastname: Kawakami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawanabe
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Soma
mesh_terms: D000368:Aged; D015139:Blotting, Southern; D017252:CD3 Complex / Q000032:analysis; D015704:CD4 Antigens / Q000032:analysis; D018956:CD5 Antigens / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D015368:Human T-lymphotropic virus 1 / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D053645:Interleukin-2 Receptor alpha Subunit / Q000032:analysis; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000276:immunology / Q000473:pathology*; D008297:Male; D016133:Polymerase Chain Reaction; D011533:Proviruses / Q000235:genetics; D012867:Skin / Q000276:immunology / Q000473:pathology*
chemical_list: D017252:CD3 Complex; D015704:CD4 Antigens; D018956:CD5 Antigens; D004279:DNA, Viral; D053645:Interleukin-2 Receptor alpha Subunit