A Rare Case of Subcutaneous Panniculitis-Like T Cell Lymphoma with Hemophagocytic Lymphohistiocytosis Mimicking Cellulitis

Patient: Male, 48-year-old Final Diagnosis: Hemophagocytic Lymphohistiocytosis • subcutaneous panniculitis-like T cell lymphoma Symptoms: Chills • erythema • fever • night sweats • subcutaneous nodules Medication: — Clinical Procedure: Autologous stem cell transplantation • chemotherapy Specialty: Dermatology • Hematology • Infectious Diseases • Medicine, General and Internal • Oncology • Pathology • Transplantology OBJECTIVE: Rare disease BACKGROUND: Subcutaneous panniculitis-like T cell lymphoma and primary cutaneous γδ T cell lymphoma are rare forms of non-Hodgkin lymphoma presenting as skin nodules or plaques. CASE REPORT: Here, we present a case of a 48-year-old man with multiple subcutaneous, tender, erythematous nodules on his right thigh and left arm. Multiple courses of antibiotics were administered with no significant improvement in the patient’s lesions. The skin biopsy report showed CD3/CD8 lymphocytic rimming of the adipocytes and the patient was diagnosed with subcutaneous panniculitis-like T cell lymphoma. A subsequent bone marrow biopsy showed hemophagocytic lymphohistiocytosis. The patient underwent treatment with the cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone, and etoposide chemotherapy regimen and received an autologous peripheral blood stem cell transplant. CONCLUSIONS: Nodular skin lesions can result from a variety of noninfectious causes in addition to bacterial and fungal infections. This case highlights the importance of early biopsy of skin lesions that do not respond to standard therapy to establish an accurate diagnosis and start timely treatment to prevent poor outcomes.