Hypoesthesia and cutaneous eruptions in a patient with T-cell lymphoma: Telltale signs of leprosy, an unrelenting ancient disease

Authors: Tiffany P. Que, Sharon Margaret V. Wong, Camille Berenguer-Angeles, Lian C. Jamisola, Cindy Jao Tan

Abstract

Introduction: The occurrence of malignant tumors associated with leprosy has been observed, with lymphoma being the most commonly associated nonepithelial malignant tumor, and may be due to the depressed immunologic surveillance. The converse where leprosy manifests in a lymphoma patient undergoing chemotherapy has also been mentioned in a few articles.

Case summary: A 49-year-old female was diagnosed to have peripheral T-cell lymphoma after an initial presentation of enlarged lymph nodes, generalized asymptomatic papules and plaques on the trunk, and pancytopenia. Two weeks after initiation of chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP), her skin lesions progressed to become violaceous to slightly hyperpigmented. Further query revealed a year-long history of hypoesthesia of the lower extremities. Histopathologic examination revealed nodular histiolymphocytic infiltrates surrounding blood vessels, adnexal structures, and nerves, consistent with lepromatous leprosy. Fite-Faraco stain was positive. Due to lymphoma-related pancytopenia, patient was given monthly rifampicin, ofloxacin and minocycline (ROM) chemotherapy, alternatively. Erythema nodosum leprosum reaction developed for which
clofazimine was given, resulting to improvement.

Conclusion: Leprosy is indeed a great mimicker and dermatologists need to be adept at diagnosing skin conditions in immunocompromised patients, especially since disease course and manifestation may be modified in this subset of patients. Leprosy must be considered when
granulomatous lesions arise in lymphoma patients before ascribing them to the underlying
disease. Management may also be challenging due to the comorbidities, which may limit
treatment options. Careful history, clinical clues, histopathologic correlation and prudent
therapeutic approach are important tools in addressing these cases.

 

Citation

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Keywords

Hansen’s, leprosy, hypoesthetic skin lesions, neoplasm, T-cell lymphoma

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