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September 20, 2010

Necrotic Papules on the Thigh of a 76-Year-Old Woman With Prolonged Fever—Diagnosis

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Arch Dermatol. 2011;147(1):109-114. doi:10.1001/archdermatol.2010.403-b

Histopathologic examination of the skin biopsy specimen showed aggregation of atypical lymphocytes within dilated vascular lumina in association with superficial and deep perivascular lymphocytic infiltrates and ulceration. Immunoperoxidase study revealed the infiltrate to be positive for CD20. Laboratory findings included mild anemia (erythrocyte count, 3.45 × 106/μL, and hemoglobin level, 9.7 g/dL), an elevated serum lactate dehydrogenase level of 829 U/L (normal range, 110-220 U/L), and an elevated erythrocyte sedimentation rate of 88 mm/h (normal range, 4-20 mm/h). (To convert erythrocytes to ×1012/L, multiply by 1.0; hemoglobin to grams per liter, multiply by 10.0; and lactate dehydrogenase to microkatals per liter, multiply by 0.0167.) Bone marrow biopsy specimens showed large atypical pleomorphic lymphoid cells in dilated sinusoids, and the diagnosis of IBL was made. The patient received treatment with cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisolone and was discharged. Unfortunately, she was lost to follow-up, and we were not able to observe her response.