ISSN:
1365-4632
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
A 48-year-old man with a history of psoriasis, who had received no oral pharmacologic treatment, presented in March 2000 with a progressive, cutaneous, pruritic eruption that began on his arms and legs, and became generalized. Examination revealed discrete, purpuric elements disseminated over the entire cutaneous surface, and in some areas confluent, large, erythematous, purpuric patches (〈link href="#f3-1 #f3-2"〉Figs 1 and 2). The palmoplantar surfaces and mucous membranes were spared. No lesions suggesting parapsoriasis or the usual presentation of cutaneous T-cell lymphoma (CTCL) were present.〈figure xml:id="f3-1"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1774:IJD_1177_f3-1"/〉Confluent, large, erythematopurpuric patches with sharply pointed purpuric elements on the buttocks〈figure xml:id="f3-2"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1774:IJD_1177_f3-2"/〉Similar lesions on the lower limbsHistopathologic examination of a cutaneous specimen showed numerous atypical lymphocytes in the superficial dermis, slight changes at the dermo-epidermal junction, and an intense epidermotrophism, with atypical lymphocytes in the epidermis. These intraepidermal atypical lymphocytes were present both isolated and forming aggregates of 4-7 cells (〈link href="#f3-3"〉Fig. 3). Immunohistochemical studies demonstrated that these lymphocytes were T-helper cells.〈figure xml:id="f3-3"〉3〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1774:IJD_1177_f3-3"/〉Atypical lymphocytes in the superficial dermis, slight changes at the dermo-epidermal junction, and intense epidermotrophism, with atypical lymphocytes. Intraepidermal lymphocytes were present both isolated and forming small cellular aggregatesRoutine laboratory tests were normal, except for slight hypercholesterolemia. Direct examination of peripheral blood, coagulation, antinuclear antibody (ANA) immunofluorescent test, body scanner, and bone marrow study were normal.CTCL stage IB was diagnosed and psoralen plus UVA (PUVA) therapy was initiated.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1365-4362.2001.11774.x
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