Paraneoplastic erythroderma: unusual presentation secondary to diffuse large B cell lymphoma

Abstract

A 34-year-old HIV-positive man presented in clinic with generalised erythroderma, having been lost to follow-up for the previous 3 years. He was CD4 lymphopenic (100×106/L) and was antiretroviral therapy naive. Initial histology from a skin punch biopsy was non-specific and he was treated with topical steroids and emollients for a suspected eczema. However, the erythroderma worsened with development of cervical lymphadenopathy and significant weight loss over a 6-week period. An incisional biopsy from the left tonsil confirmed a diagnosis of diffuse large B-cell lymphoma. The erythroderma was considered to be a paraneoplastic skin phenomenon. The patient received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone (CHOP) immunochemotherapy with gradual but complete resolution of the erythroderma. Paraneoplastic dermatoses can manifest as first clinical sign of underlying malignancy, heralding a cancer diagnosis. This is particularly important in people living with HIV given the increased incidence of malignancy in this patient group.

Paraneoplastic erythroderma: an insight on the existing data

“…Multiple case series or case reports on isolated cases bring light to the clinical characteristics of patients who present with paraneoplastic erythroderma (Table 2). 23–51 …”

“…The majority of the case reports concerning patients with paraneoplastic erythroderma concern mostly patients with a pulmonary malignancy, 23–28 hematologic malignancies other than mycosis fungoides or Sezary syndrome, 29–36 and malignancies of the gastrointestinal tract 37–45 . Isolated reports on erythroderma associated with other visceral malignancies less frequently seen, such as renal, breast, or prostate cancer, are also present in the literature 46–51 …”

“…A careful examination of the reported cases reveals that paraneoplastic erythroderma tends to affect mainly the elderly population, with its incidence peaking after the sixth decade of life 23–51 . Malignancy‐associated erythroderma is only rarely seen in younger adults 30,34,35 .…”

“…A careful examination of the reported cases reveals that paraneoplastic erythroderma tends to affect mainly the elderly population, with its incidence peaking after the sixth decade of life 23–51 . Malignancy‐associated erythroderma is only rarely seen in younger adults 30,34,35 . Another interesting observation is the fact that in almost all cases, the performed skin biopsy demonstrates mostly nonspecific findings, such as acanthosis, spongiosis, and perivascular infiltration of inflammatory cells, thus failing to be of real diagnostic value 26–35,38–40,42–51 .…”

“…30,34,35 Another interesting observation is the fact that in almost all cases, the performed skin biopsy demonstrates mostly nonspecific findings, such as acanthosis, spongiosis, and perivascular infiltration of inflammatory cells, thus failing to be of real diagnostic value. [26][27][28][29][30][31][32][33][34][35][38][39][40][42][43][44][45][46][47][48][49][50][51] Cases where the skin biopsy was indicative of a potential occult malignancy were when a coexisting dermatosis, such as dermatomyositis, was diagnosed. 36,37,41 Since dermatomyositis is considered to constitute a facultative paraneoplastic dermatosis itself, 37 the diagnostic examinations on those patients were oriented faster toward screening for a malignant process.…”