Cutaneous T-Cell Lymphoma

Three months ago, a 50-year-old man who was otherwise in good health noticed a hard, round nodule on his left arm. Within 2 months, similar nodules appeared all over his trunk, head, arms, and legs. The reddish purple lesions, less than 2 cm in diameter, were painless and slightly pruritic.

The patient was hospitalized, at which time neither lymphadenopathy nor organomegaly was noted. Results of a complete blood cell count, biochemical studies, and urinalysis were normal, and an ECG, a chest film, and CT studies of the thorax and abdomen revealed no abnormalities. Serologic tests were negative for hepatitis B and C viruses, Epstein-Barr virus, cytomegalovirus, HIV, human T-cell leukemia/lymphoma-1 and -2 viruses, rickettsiae, and Treponema pallidum. Biopsy results of bone marrow aspirate were inconclusive.

The diagnosis was obtained from histopathologic examination of a skin biopsy specimen: high-grade cutaneous T-cell lymphoma. The patient was placed on a chemotherapy regimen consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and a remarkable regression of the skin lesions was evident after 40 days.

This case was reported by Drs Nicholas Pritsivelis, Haralampos Milionis, and Moses Elisaf of Ioannina, Greece.