Title: Overcoming the difficulties in diagnosing cutaneous T-cell lymphoma
Abstract: A 19-year-old Caucasian woman was referred to dermatology for new-onset erythematous nodules that had been present on her arms and legs for several months.She denied pruritus and pain.Her initial skin biopsy was read at another institution as lupus panniculitis and she was subsequently placed on quinine therapy.Despite several months of therapy, the patient continued to develop new nodules with no improvement in the existing nodules.Her subsequent biopsies showed scant upper dermal perivascular lymphohistiocytic infiltrate and a dense lobular infiltrate composed of pleomorphic hyperchromatic lymphoid cells.Eighty percent of these cells stained for CD8, a T suppressor cell marker, whereas only 30% stained for CD4, a T helper cell marker.Cytotoxic granular protein T-cell intracellular antigen (TIA-1) was focally positive.Large cytophagic histiocytes were also noted.