Charest Guy, McBride Michael, Thomas Amanda K, Manway Mitch, DiCaudo David J
Dermatology, HonorHealth Dermatology Residency Program, Scottsdale, USA.
Dermatology, Creighton University School of Medicine, Phoenix, USA.
Cureus. 2023 Sep 6;15(9):e44805. doi: 10.7759/cureus.44805. eCollection 2023 Sep.
Angioimmunoblastic T-cell lymphoma (AITL) is a subtype of peripheral T-cell lymphoma with a nonspecific clinical presentation. Cutaneous manifestations of AITL are variable and include morbilliform eruptions, urticaria, papulonodules, and erythroderma. We present the case of a 74-year-old male with a medical history of AITL presenting with diffuse erythematous macules and papules coalescing into patches and plaques on the trunk and bilateral upper extremities. Histopathology demonstrated a mild perivascular lymphocytic infiltrate in the dermis. By immunohistochemistry, the lymphocytic infiltrate was strongly positive for programmed cell death protein 1 (PD-1) (CD279) as well as cluster of differentiation 3 (CD3), CD5, and (focally) B-cell lymphoma-6 (BCL-6). Many cells within the infiltrate were positive for Epstein-Barr virus (EBV) by in situ hybridization. Additionally, a bone marrow biopsy demonstrated an atypical lymphoid infiltrate with T-cell predominance, many EBV-positive cells, and clonal T-cell receptor (TCR) beta gene rearrangement. Based on these histopathological findings, a diagnosis of recurrent AITL with cutaneous involvement was made. This case is a rare example of skin findings presenting as a first sign of recurrent AITL.
血管免疫母细胞性T细胞淋巴瘤（AITL）是外周T细胞淋巴瘤的一种亚型，临床表现不具特异性。AITL的皮肤表现多样，包括麻疹样皮疹、荨麻疹、丘疹结节及红皮病。我们报告一例74岁男性患者，有AITL病史，躯干和双侧上肢出现弥漫性红斑丘疹，融合成斑片和斑块。组织病理学显示真皮轻度血管周围淋巴细胞浸润。免疫组化显示，淋巴细胞浸润对程序性细胞死亡蛋白1（PD-1，即CD279）以及分化簇3（CD3）、CD5和（局灶性）B细胞淋巴瘤-6（BCL-6）呈强阳性。浸润内许多细胞经原位杂交检测显示爱泼斯坦-巴尔病毒（EBV）阳性。此外，骨髓活检显示非典型淋巴样浸润，以T细胞为主，有许多EBV阳性细胞及克隆性T细胞受体（TCR）β基因重排。基于这些组织病理学发现，诊断为复发性AITL伴皮肤受累。该病例是皮肤表现作为复发性AITL首发征象的罕见例子。
