<p class="abstract">Peripheral T-cell lymphoma (PTCL), a subdivision of T-cell non-Hodgkin lymphomas (NHLs), is rare and different from the more common cutaneous T-cell lymphomas. PTCL is a diverse group of disorders and carries a poor prognosis. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) is the most common and aggressive disorder out of the group, which involves the lymph nodes followed by the skin, liver, and gastrointestinal tract. We hereby report a case of a 60 years old female who presented to us with complaints of multiple painful dark-coloured nodular lesions and indurated plaques over bilateral upper limbs, lower limbs and trunk, for 3 months. After detail laboratory investigations, histopathological and immunohistochemistry which was positive for CD30 antigen we confirmed the diagnosis as PTCL-NOS.  Radiological imaging showed involvement of gastrointestinal tract, adrenal gland and vertebrae. After thorough workup the patient was started on palliative radiotherapy, unfortunately she succumbed to death. In conclusion, PTCL-NOS with CD30 positivity is rare and aggressive with a poor prognosis, it is important to identify such cases and work in conjugation with an oncologist for proper management.</p>

<p>Erythromelalgia presents with redness, pain and warmth of the extremities, which is exacerbated by warming and relieved by cooling. Treatment of pain in erythromelalgia can be difficult, and often polypharmacy is utilized. No single therapy has been found to provide complete relief for any patient. Therefore, a multidisciplinary approach is required to treat pain and its significant negative impact across many domains of functioning. A 21 year old male diagnosed case of primary erythromelalgia since 5 years, presented multiple times with recurrent pain and erythema in bilateral lower limbs. Patient was treated initially with oral antibiotics, tramadol and prednisolone, without relief. Aspirin, amitriptyline, pregabalin, carbamazepine, atenolol were later added which gave him partial relief. Epidural caudal catheter with daily infusion of anesthesia was added along with topical buprenorphine patch when conservative polypharmacy failed to provide complete relief and later unilateral lumbar sympathectomy was done as a last resort. Adding pentoxifylline and compression therapy improved the patient’s condition drastically and complete remission is in progress. The patient required a multidisciplinary approach for pain management and surgical intervention was required due to his refractory nature. However, this also does not give complete relief and thus a combination of both medical and surgical methods is required for best control of symptoms.</p>

<p class="abstract">Primary cutaneous diffuse large B cell lymphoma, leg type (PCDLBCL-LT) is a rare and aggressive type of primary cutaneous B cell lymphoma (PCBCL), which represents 10-20% cases of PCBCL. It has a 40-50% recurrence rate and 5 year survival rate of 50%. Here, we present a case of an 86 year old female who presented to us with complaints of slightly tender annular plaques with an oedematous base present over bilateral lower limbs and pitting oedema. Histopathological examination from the annular lesion showed normal epidermis, grenz zone and a dense lymphoid infiltrate involving almost the entire dermis. Immunohistochemistry confirmed histological findings, atypical cell were positive for CD20 and MUM1 protein with focal expression of BCL 6 which is rare. Based on the above findings, we made a diagnosis of diffuse large B cell lymphoma-leg type and started her on palliative radiotherapy. As PCBCL-LT is rare and aggressive lymphoma, we present this case to review literature and summarise its clinical features.</p>

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