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Oct 2012

Acute Onset of Leg Nodules in a Sporotrichoid Pattern—Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD

Arch Dermatol. 2012;148(10):1200. doi:10.1001/archderm.148.10.1200-b

Histopathologic examination of the skin biopsy specimens showed extensive involvement by a diffuse deep dermal and subcutaneous infiltrate composed of large cells with oval to irregular nuclei, vesicular chromatin, and multiple nucleoli. Numerous apoptotic bodies and occasional mitoses were noted. The epidermis was uninvolved. Neoplastic cells were positive for CD20, MUM-1, bcl-2, bcl-6, and Ki-67 and negative for CD10. Tissue culture was negative for microorganisms. Bone marrow studies showed normal trilineage hematopoiesis without evidence of involvement by lymphoma. Laboratory evaluation revealed a depressed white blood cell count (3500/μL) and hemoglobin level (9.2 g/dL) and an elevated lactate dehydrogenase level (263 U/L). Positron emission tomography and computed tomography showed hypermetabolic nodules on the skin of the right leg, with no evidence of lymph node or visceral involvement. Our patient received local radiation to his leg but was unable to receive chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab because of medical comorbidities. He died of respiratory failure 4 months after diagnosis. Postmortem examination showed widely disseminated lymphoma involving the patient's lungs, adrenal glands, liver, and kidneys as well as multiple lymph nodes.

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