title: [Lymphomatoid granulomatosis revealed by cutaneous lesions].
abstract: BACKGROUND
  Lymphomatoid granulomatosis is a rare Epstein Barr virus (EBV)-related lymphoproliferative disorder. It most frequently involves the lungs, skin and central nervous system and arises preferentially in patients with immune disorders. Here we report a case revealed by cutaneous lesions in an immunocompetent patient.
  
  
  METHODS
  A 56-year-old man consulted for erythematous nodules of the trunk associated with malaise and marked weight loss (14kg). In a few days the nodules became necrotic. Two weeks later a cough appeared and the chest computerized tomography showed multiple poorly defined nodular opacities with a peribronchovascular distribution. Cutaneous and pulmonary biopsies showed an infiltrate composed of medium-sized atypical lymphocytes T and B. EBV was present in the infiltrate (in situ hybridization) with a high EBV load in plasma. All of these data helped confirm the diagnosis of lymphoid granulomatosis. Despite aggressive treatment with polychemotherapy, the patient died after 2 months.
  
  
  CONCLUSIONS
  Lymphomatoid granulomatosis represents a diagnostic challenge. In most cases, the presenting symptoms are not specific: malaise, weight loss, fever and cough. Moreover histology is difficult because of the T-cell-rich background. It is essential to consider this diagnosis in cases of cutaneous and pulmonary symptoms.
authors: Clinique dermatologique, CHU de Nantes, 1, place A.-Ricordeau, 44093 Nantes cedex 01, France.
authors: G
authors: G
authors: Quéreux
authors: A
authors: A
authors: Brocard
authors: L
authors: L
authors: Peuvrel
authors: A-C
authors: AC
authors: Knol
authors: J-J
authors: JJ
authors: Renaut
authors: B
authors: B
authors: Dréno
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000473:pathology / Q000821:virology; D003371:Cough / Q000209:etiology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis*; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007121:Immunocompetence; D008168:Lung / Q000473:pathology / Q000821:virology; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology; D008230:Lymphomatoid Granulomatosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012867:Skin / Q000473:pathology*; D013601:T-Lymphocytes / Q000473:pathology; D014750:Vincristine / Q000008:administration & dosage; D019562:Viral Load
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone