Fatal Case of Subcutaneous Panniculitis T-Cell Lymphoma Mimicking Polyarteritis Nodosa: A Case Report and Review of Literature

Abstract

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare subtype of cutaneous T-cell lymphoma. These cases can remain undiagnosed and are often treated with prolonged and ineffective immunosuppressive agents before a diagnosis of T-cell lymphoma is made. A 76-year-old white male presented with a 3-month history of fatigue, weight loss, night sweats, low grade fevers, gradual cognitive decline, and new onset skin lesions. Skin examination revealed mildly tender, indurated, dull red subcutaneous nodules on face, chest, back, upper, and lower extremities, most numerous on the chest and back. A punch biopsy from one of the skin nodules revealed small and medium vessel vasculitis with associated neutrophilic lobular panniculitis. A full thickness skin biopsy showed inflammatory infiltrate composed predominantly of atypical small to medium sized lymphocytes with hyperchromatic nuclei. A diagnosis of T-cell lymphoma was made on clinical presentation, histopathology, immunohistochemical and molecular studies. SPTL can mimic autoimmune diseases including primary vasculitis disorder in presentation. A superficial skin biopsy may be sufficient in diagnosing SPTL; however, presence of vasculitis on a superficial punch biopsy specimen should be followed by deep incisional biopsy (sometimes multiple) in all cases with atypical presentation or those who do not respond appropriately to treatment.