A novel case of reactive perforating collagenosis in a patient with cutaneous infiltration of Epstein–Barr virus-positive angioimmunoblastic T-cell lymphoma

Abstract

Reactive perforating collagenosis (RPC) is a cutaneous disorder that has rarely been associated with hematologic malignancies. We present a case of a 47-year-old man with a six-month history of Epstein Barr Virus (EBV)-positive angioimmunoblastic T cell lymphoma (AITL) currently undergoing chemotherapy who presented with an extremely pruritic, papular eruption that had worsened over the past seven months. Skin biopsy findings revealed RPC. He was treated with triamcinolone cream and hydroxyzine alongside his chemotherapy, which resolved his symptoms. This case offers a unique clinicopathologic presentation of RPC in the setting of AITL in the skin and demonstrates the importance of a dermatologist's management of cutaneous disorders in cancer patients to improve their quality of life. Angioimmunoblastic T-cell lymphoma (AITL) is a relatively uncommon subtype of mature peripheral T-cell lymphoma (PTCL) that represents 1-2% of all non-Hodgkin lymphomas. AITL typically follows an aggressive course resulting in a poor prognosis with a median five-year survival of 33%.1 Some studies have suggested an associated skin rash or pruritus as an indicator of poorer prognosis.1 Cutaneous involvement can be found in 20-50% of AITL patients, with presentations ranging from urticaria to nodular lesions.1 Dermatologists can significantly improve quality of life for cancer patients by correctly diagnosing cutaneous eruptions in the setting of malignancy and anti-cancer therapy, thereby alleviating dermatologic adverse effects (DAEs) and interruptions in treatment.2 We report a case of acquired reactive perforating collagenosis (RPC) associated with cutaneous infiltration of Epstein-Barr Virus (EBV)-positive AITL.