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Case Reports
. 2021 Jan 11:22:e927142.
doi: 10.12659/AJCR.927142.

A Rare Case of Subcutaneous Panniculitis-Like T Cell Lymphoma with Hemophagocytic Lymphohistiocytosis Mimicking Cellulitis

Aniket Mody  1 , Daniel Cherry  2 , Georgiana Georgescu  3 , Cyenthia Koehler  4 , Veenu Gill  5
Affiliations
Case Reports

A Rare Case of Subcutaneous Panniculitis-Like T Cell Lymphoma with Hemophagocytic Lymphohistiocytosis Mimicking Cellulitis

Aniket Mody et al. Am J Case Rep. .

Abstract

BACKGROUND 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.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
The right upper thigh revealed several discrete areas of induration with overlying warmth and erythema, including an ulcer at the superior lateral thigh.
Figure 2.
Figure 2.
The left arm showed an area of induration laterally with surrounding erythema extending to the wrist, and serous drainage.
Figure 3.
Figure 3.
Excisional biopsy showing subcutaneous panniculitis-like T cell lymphoma involving the fat lobules with sparing of the overlying cutaneous tissue (×20, hematoxylin and eosin stain).
Figure 4.
Figure 4.
CD3 immunohistochemical stain of the atypical lymphocytes with hyperchromic nuclei in a membranous distribution, demonstrating T cell lineage (×400).
Figure 5.
Figure 5.
CD8 immunohistochemical stain highlights the atypical lymphocytes with hyperchromic nuclei in a membranous distribution, also demonstrating T cell lineage (×400).
Figure 6.
Figure 6.
Rimming of the adipocytes by lymphocytes with nuclear atypia (×400, hematoxylin and eosin stain).
Figure 7.
Figure 7.
Histiocyte with phagocytosed erythroid precursors (Wright stain, ×100 magnification).
Figure 8.
Figure 8.
Histiocyte with phagocytosed neutrophil (Wright stain, ×100 magnification).
Figure 9.
Figure 9.
Histiocyte with phagocytosed erythroid precursor and platelets (Wright stain, ×100 magnification).
See this image and copyright information in PMC

References

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