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. 2017 Jul 6;5(3):2324709617716471.
doi: 10.1177/2324709617716471. eCollection 2017 Jul-Sep.

Extranodal NK/T-Cell Lymphoma, Nasal Type, Presenting as Refractory Pseudomonas aeruginosa Facial Cellulitis

Erika Reategui Schwarz  1   2 , Katerina G Oikonomou  1   2 , Megan Reynolds  3 , Juliette Kim  2 , Rajeev L Balmiki  1   2 , Stephanie A Sterling  1   2
Affiliations

Extranodal NK/T-Cell Lymphoma, Nasal Type, Presenting as Refractory Pseudomonas aeruginosa Facial Cellulitis

Erika Reategui Schwarz et al. J Investig Med High Impact Case Rep. .

Abstract

Extranodal natural killer T-cell lymphoma, nasal type (ENKL), formerly called lethal midline granuloma or angiocentric T-cell lymphoma, is a predominantly extranodal non-Hodgkin lymphoma characterized by vascular damage, necrosis, and an association with Epstein-Barr virus. In the United States, it is more frequently seen in Asian, Asian Pacific Islander, and Hispanic descent populations and is more prevalent in males in their fifth decade. Clinical presentation of NK nasal lymphoma most commonly involves epistaxis; obstruction; discharge; destructive mass in sinuses, palate, and nose; and skin ulceration. These symptoms can mimic invasive fungal infections and other sinonasal disorders. Furthermore, ENKL has a broad cytologic spectrum and induces a mixture of inflammatory cells, causing difficulty in establishing the diagnosis, especially in initial biopsies. We present a case of refractory Pseudomonas aeruginosa facial cellulitis in a young woman whose treatment course was complicated by septic shock and resistance to multiple antibiotics, resulting in a delayed diagnosis of ENKL nasal type.

Keywords: ENKL; Epstein-Barr virus infections/virology; United States; extranodal NK-T-cell/pathology; humans; lymphoma.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Right premaxillary mass immunohistochemistry: (a) Immunohistochemistry CD3+ MP ×10; (b) Immunohistochemistry CD3+ HP ×40.
Figure 2.
Figure 2.
Right nares lesion during hospitalization course and after discharge: (a) Initiation of chemotherapy; (b) Three months after discharge.
See this image and copyright information in PMC

References

    1. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117:5019-5032. - PMC - PubMed
    1. Tse E, Kwong YL. How I treat NK/T-cell lymphomas. Blood. 2013;121:4997-5005. - PubMed
    1. Marchino T, Ibáñez N, Prieto S, et al. An aggressive primary orbital natural killer/T-cell lymphoma case: poor response to chemotherapy. Ophthal Plast Reconstr Surg. 2014;30:e131-e134. - PubMed
    1. Gill H, Liang RH, Tse E. Extranodal natural-killer/T-cell lymphoma, nasal type. Adv Hematol. 2010;2010:627401. - PMC - PubMed
    1. Haverkos BM, Pan Z, Gru AA, et al. Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT): an update on epidemiology, clinical presentation, and natural history in North American and European cases. Curr Hematol Malig Rep. 2016;11:514-527. - PMC - PubMed

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