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   Abstract
   Introduction
   Case Report
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CASE REPORT
Year : 1995  |  Volume : 61  |  Issue : 1  |  Page : 45-47

Cutaneous lymphoma mimicking seborrhoeic dermatitis




Correspondence Address:
Sri Venkateswaran


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Source of Support: None, Conflict of Interest: None


PMID: 20952875

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  Abstract 

A case of non Hodgkins lymphoma presenting with cutaneous lesions mimicking seborrhoeic dermatitis is reported. Clinician should have a high index of suspicion to diagnose lymphoma in its early stage, since it can mimic many benign dermatoses.


Keywords: Lymphoma, Seborrhoeic dermatitis


How to cite this article:
Venkateswaran S, Garg B R, Reddy B, Narasimhan. Cutaneous lymphoma mimicking seborrhoeic dermatitis. Indian J Dermatol Venereol Leprol 1995;61:45-7

How to cite this URL:
Venkateswaran S, Garg B R, Reddy B, Narasimhan. Cutaneous lymphoma mimicking seborrhoeic dermatitis. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Nov 21];61:45-7. Available from: http://www.ijdvl.com/text.asp?1995/61/1/45/4129



  Introduction Top


Clinical presentation of cutaneous lymphoma is varied and deceptive in its early stage. The most common initial diagnosis for these patients is 'eczema'.[1] Premycotic stages of cutaneous lymphoma has been reported as simulating seborrhoeic dermatitis, contact dermatitis, neurodermatitis, psoriasis, fixed drug eruptions.[2] These non diagnostic lesions can persist for years with slow spread. Herewith we report a case of cutaneous lymphoma presenting as seborrhoeic dermatitis for its clinical interest.


  Case Report Top


A 42-year-old man reported to our outpatient department with pruritic, moist skin lesions over scalp, face and body folds of one year duration. The patient initially developed an asymptomatic solitary reddish plaque associated with oozing over the scalp. Later similar lesions appeared over the groins, axillae, face and neck. Six months later he also noticed swelling of the upper lip with hoarseness of voice. There were no systemic complaints.

On examination, the patient had extensive erythematous crusted lesions which were oozing with foul smelling discharge over the seborrhoeic sites of the body (scalp, face, neck, axillae, groins). In addition he had diffuse, oedematous, painless, swollen upper lip.

Patient was diagnosed as a case of seborrhoeic dermatitis and hospitalized for management. He was started on systemic antibiotics and topical Condy's compresses with which his condition improved. Oozing and crusting cleared but erythema and induration of skin persisted. During the hospital stay, the lesions gradually became more tumid with diffuse infiltration of the face leading to leonine faes. [Figure - 1] & [Figure - 2]. At this stage, the lesions were well to ill defined plaques with irregular sloping borders and a smooth non-ulcerated surface. There was no tenderness or sensory loss over the scalp lesions. Later ichthyotic lesions were also observed over the extremities, back and chest.

Haemaological investigations were normal except for a mild leucocytosis. Peripheral smear did not show any atypical cells. Biochemical investigations were within normal limits. Serology showed hepatitis B surface antigen while HIV serology was negative. Skiagram of chest and ultrasonogram of the abdomen were within normal limits. Direct laryngoscopy revealed diffuse mucosal oedema with normal vocal cords. Skin biopsies were done three times. Though the earlier two were reported as nonspecific, the third skin biopsy along with a lymph node biopsy clinched the diagnosis of Non Hodgkins lymphoma (diffuse, small cell cleaved type). The skin biopsy showed a diffuse infiltrate of small monomorphous type of cleaved cells. [Figure - 3]. The lymph node architecture was replaced by a diffuse sheet of similar cells.

He was started on CHOP (Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) cycles given every three weeks. After three cycles of therapy, he showed 50% decrease in the thickness of the lesions with disappearance of erythema and crustings. At the end of fifth cycle he showed 90% decrease in erythema and induration.


  Discussion Top


Beginning with a premycotic erythematous or eczematous stage, cases of cutaneous lymphoma slowly progress to an infiltrative 'plaque' stage and eventuate in the 'tumour' state.[3] Variants like verrucous, bullous, pustular, purpuric, hyperkeratotic, hypopigmented, erythrodermic and poikilodermic lesions have also been described.[4] Our patient presented with a seborrhoeic dermatitis-like picture with eczematous involvement of all seborrhoeic areas. However, the clinical course in the hospital helped us to suspect a more sinister diagnosis which turned out to be a malignant lymphoma predominantly affecting the skin. In addition he had infiltration of the mucous membranes (oedematous lips and buccal mucosa, hoarseness of voice) which is not very commonly reported. The leonine facies in our patients has been noted in earlier reports also.[5]

Some factors associated with increased risk of development of malignant lymphomas include inherited and acquired immunodeficiency disease, autoimmune diseases, chemicals, drug exposure and association with viral infection (EB virus, HTLV etc).[6] It is interesting to note that our patient was positive for hepatitis B surface antigen. The role of viruses in the causation of lymphomas is to be stressed here.[7]

 
  References Top

1.Heald PW, Edelson RL. Cutaneous lymphomas and related disorders. In : Dermatology in General Medicine (Fitzpatrick TB, Eisen AZ, Wolff K. et al, eds). 4th edn. Philadelphia : McGraw Hill, 1993;1286-306.  Back to cited text no. 1    
2.Ackerman AB, Miller RC: Pustular Mycosis fungoides. Arch Dermatol 1966;93:221-5.  Back to cited text no. 2    
3.Foon KA, Gale RP. Cutaneous T-cell lymphoma. In : Haematology - Clinical and Laboratory Practice (Bick RL, Benett. et al, eds). 2nd edn. St Louis: Mosby 1993;841-4.  Back to cited text no. 3    
4.Dabski K, Stoll HL, Milgrom H. Unusual clinical presentation of epidermotrophic cutaneous lymphoma. Int J Dermatol 1985;24:108-15.  Back to cited text no. 4    
5.Knobler RM, Edelson RL. Cutaneous T Cell Lymphoma. In : Medical Clinics of North America - Cutaneous Oncology (Callen JP, Allegra J, eds). Philadelphia: WB Saunders, 1986;109-25.  Back to cited text no. 5    
6.Freedman AS, Nadler LM. Malignant lymphoma. In : Harrison's Principles of Internal Medicine (Isselbacher, Braunwald, Wilson, et al, eds). 13th edn. Philadelphia : McGraw Hill, 1994;1774-88.  Back to cited text no. 6    
7.Mackie RM: Initial event in MF is viral infection of epidermal Langerhan cells. Lancet 1981;ii:283-4.  Back to cited text no. 7    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

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