Lim Puo Nen, Fox Christopher P, Pammi Manjula, Patel Anand
Department of Genitourinary Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
BMJ Case Rep. 2019 May 30;12(5):e228412. doi: 10.1136/bcr-2018-228412.
A 34-year-old HIV-positive man presented in clinic with generalised erythroderma, having been lost to follow-up for the previous 3 years. He was CD4 lymphopenic (100×10/L) and was antiretroviral therapy naive. Initial histology from a skin punch biopsy was non-specific and he was treated with topical steroids and emollients for a suspected eczema. However, the erythroderma worsened with development of cervical lymphadenopathy and significant weight loss over a 6-week period. An incisional biopsy from the left tonsil confirmed a diagnosis of diffuse large B-cell lymphoma. The erythroderma was considered to be a paraneoplastic skin phenomenon. The patient received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone (CHOP) immunochemotherapy with gradual but complete resolution of the erythroderma. Paraneoplastic dermatoses can manifest as first clinical sign of underlying malignancy, heralding a cancer diagnosis. This is particularly important in people living with HIV given the increased incidence of malignancy in this patient group.
一名34岁的HIV阳性男子前来诊所就诊，全身弥漫性红皮病，此前3年失访。他的CD4淋巴细胞减少（100×10⁶/L），且未接受过抗逆转录病毒治疗。皮肤打孔活检的初始组织学检查结果无特异性，他因疑似湿疹接受了外用类固醇和润肤剂治疗。然而，在6周内，随着颈部淋巴结病的出现和体重显著减轻，红皮病恶化。左侧扁桃体的切开活检确诊为弥漫性大B细胞淋巴瘤。红皮病被认为是一种副肿瘤性皮肤现象。患者接受了利妥昔单抗、环磷酰胺、盐酸多柔比星、长春新碱和泼尼松龙（CHOP）免疫化疗，红皮病逐渐完全消退。副肿瘤性皮肤病可表现为潜在恶性肿瘤的首个临床症状，预示着癌症的诊断。鉴于该患者群体中恶性肿瘤发病率增加，这对HIV感染者尤为重要。
