A Rare Case of Subcutaneous Panniculitis-Like T Cell Lymphoma with Hemophagocytic Lymphohistiocytosis Mimicking Cellulitis
Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Aniket Mody, Daniel Cherry, Georgiana Georgescu, Cyenthia Koehler, Veenu Gill
Department of Internal Medicine, Abrazo Arrowhead Hospital, Glendale, AZ, USA
Am J Case Rep 2021; 22:e927142
Available online: 2020-11-19
Subcutaneous panniculitis-like T cell lymphoma and primary cutaneous γdelta T cell lymphoma are rare forms of non-Hodgkin lymphoma presenting as skin nodules or plaques.
CASE REPORT: Here, we present a case of a 48-year-old man with multiple subcutaneous, tender, erythematous nodules on his right thigh and left arm. Multiple courses of antibiotics were administered with no significant improvement in the patient’s lesions. The skin biopsy report showed CD3/CD8 lymphocytic rimming of the adipocytes and the patient was diagnosed with subcutaneous panniculitis-like T cell lymphoma. A subsequent bone marrow biopsy showed hemophagocytic lymphohistiocytosis. The patient underwent treatment with the cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone, and etoposide chemotherapy regimen and received an autologous peripheral blood stem cell transplant.
CONCLUSIONS: Nodular skin lesions can result from a variety of noninfectious causes in addition to bacterial and fungal infections. This case highlights the importance of early biopsy of skin lesions that do not respond to standard therapy to establish an accurate diagnosis and start timely treatment to prevent poor outcomes.
Keywords: Biopsy, Cellulitis, Hematopoietic Stem Cell Transplantation, Lymphohistiocytosis, Hemophagocytic, Lymphoma, Non-Hodgkin, Lymphoma, T-Cell, Cutaneous