title: Diffuse large B-cell lymphoma presenting with extensive cutaneous infiltration.
abstract: We report a case of systemic diffuse large B-cell lymphoma presenting with extensive infiltration of the skin. A 56-year-old woman presented with a two-month history of pruritic erythematous plaques and nodules over the neck, trunk and upper limbs. She also had night sweats, weight loss, lethargy and reduced effort tolerance. Systemic examination revealed a pale, ill appearance with hepatosplenomegaly and lymphadenopathy. Blood investigations showed pancytopenia (haemoglobin 6.3 g/dL, total white cell count 3.0 × 10(9)/L, platelet count 138 × 10(9)/L) with a few suspicious mononuclear cells and a mildly elevated lactate dehydrogenase level (478 U/L). Skin biopsy demonstrated diffuse sheets and nodular infiltrates of CD20 and CD79a positive neoplastic cells in the dermis and subcutis. Computed tomography revealed multiple cervical, axillary, mediastinal, para-aortic and mesenteric lymph nodes. Bone marrow aspiration and trephine biopsy confirmed marrow involvement by non-Hodgkin's lymphoma. The patient was treated with chemotherapy, which resulted in resolution of the skin lesions.
authors.affiliation: Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Selangor, Malaysia. aliffarhan@yahoo.com
authors.forename: Norashikin
authors.initials: N
authors.lastname: Shamsudin
authors.forename: Choong Chor
authors.initials: CC
authors.lastname: Chang
mesh_terms: D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D008875:Middle Aged; D010198:Pancytopenia / Q000209:etiology; D011537:Pruritus / Q000209:etiology; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*