Kaneoka Ayaka, Akamatsu Yoko, Hara Reiko, Sugiyama Akiko, Setoguchi Mihoko
Department of Dermatology, University of Occupational and Environmental Health, Japan.
Department of Dermatology, Japan Community Health Care Organization, Shimonoseki Medical Center.
J UOEH. 2022;44(3):293-299. doi: 10.7888/juoeh.44.293.
A 84-year-old female noticed erythema over her whole body for several months and was referred to our department for evaluation of her skin eruption. A physical examination revealed millet-sized erythematous papules and macules all over her body, a high body temperature, and a decreased level of consciousness. A laboratory examination showed an elevated white blood cell count (8200/μl), atypical lymphocytes (3%) and sIL-2R (4030U / ml). Computed Tomography showed systemic lymphadenopathy. A lymph node biopsy taken from the left inguinal lymph node revealed destruction of the lymph nodes, enlargement of the high endothelial venules, and atypical lymphocyte infiltration. Based on the clinical findings and laboratory examination, we diagnosed angioimmunoblastic Tcell lymphoma (AITL). AITL is a relatively rare peripheral T-cell lymphoma with severe systemic symptoms such as fever and lymph node swelling. While approximately half of all cases experience skin symptoms, which are one of the initial symptoms, it is difficult to determine the diagnosis due to the various clinical features or many non-specific rashes. We should keep in mind a differential diagnosis of lymphoma in cases of the presence of persistent eruption, systemic symptoms, and the existence of atypical lymphocytes in peripheral blood.
一名84岁女性数月来全身出现红斑，遂转诊至我科评估皮疹情况。体格检查发现全身有粟粒大小的红斑丘疹和斑疹，体温升高，意识水平下降。实验室检查显示白细胞计数升高（8200/μl），非典型淋巴细胞（3%）及可溶性白细胞介素-2受体升高（4030U/ml）。计算机断层扫描显示全身淋巴结病。取自左腹股沟淋巴结的活检显示淋巴结破坏、高内皮小静脉增大及非典型淋巴细胞浸润。基于临床表现和实验室检查，我们诊断为血管免疫母细胞性T细胞淋巴瘤（AITL）。AITL是一种相对罕见的外周T细胞淋巴瘤，伴有发热和淋巴结肿大等严重全身症状。虽然约一半的病例会出现皮肤症状，且是初始症状之一，但由于临床特征多样或皮疹多不具特异性，故难以确诊。对于存在持续性皮疹、全身症状及外周血中出现非典型淋巴细胞的病例，我们应牢记淋巴瘤的鉴别诊断。
