A dramatic presentation of an unusual form of cutaneous lymphoma.
We report an unusual and dramatic presentation of a rare form of cutaneous lymphoma, known as subcutaneous panniculitis-like T-cell lymphoma (SPTCL). This patient presented with a pruritic, florid and purpuric rash that was diagnosed as lobular panniculitis and treated with oral steroids for 1 year with no success. His skin lesions would return each time oral corticosteroids were being weaned off. Upon presentation to our clinic, repeated deep skin biopsies with immunohistochemical analysis coupled with the clinical history of persistent B symptoms and the presence of pancytopenia helped clinched the rare diagnosis of SPTCL with hemophagocytosis. The patient was then started on cyclosporine and dexamethasone before definitive chemotherapy. This rare and diagnostically challenging condition is commonly misdiagnosed as benign panniculitis or eczema, and highlights the importance of repeated skin biopsies.
Department of Medicine, National University Hospital, Singapore.
Sam Shiyao
SS
Yang
Department of Medicine, National University Hospital, Singapore.
Pei Qi
PQ
Su
Department of Pathology, National University Hospital, Singapore.
Kong-Bing
KB
Tan
Department of Medicine, National University Hospital, Singapore.
Derrick Chen-Wee
DC
Aw
Lymphoma; panniculitis; purpura; subcutaneous panniculitis-like T-cell lymphoma