A case of intravascular large B‐cell lymphoma mimicking erythema nodosum: the importance of multiple skin biopsies

Abstract

This is a unique case for two following reasons: 1) the first biopsy revealed non-specific findings compatible with erythema nodosum; and 2) before the treatment, the nodules regressed spontaneously. Dermatologists should take multiple skin biopsies for EN lesions with the non-specific histopathological findings not to refute the existence of this disease.

Intravascular Lymphoma Presenting as Telangectasias: Response to Rituximab and Combination Chemotherapy

“…10,11 In our patient, induration was a minor feature while telangectases were marked. Unusual skin findings have included generalized telangectasia, 12 asymptomatic purpuric patches, 13 panniculitis-like lesions with spontaneous regression, 14 and Kaposi sarcoma-like lesions. 4 Because of the variation in cutaneous findings, the differential diagnosis of intravascular lymphoma may be broad (Table I).…”

“…16 Autopsy reports typically show multisystem involvement with pulmonary failure, cerebrovascular infarcts, and brain metastasis being prominent. 2,3,5,14 More recently, combination chemotherapy has been reported to induce long-term survival or complete remission. In a review of 35 patients treated with chemotherapy, DiGuiseppi et al 17 reported long-term remission (up to 48 months of followup) in 43% of patients treated with chemotherapy regimes typically used for high-grade lymphomas.…”

“…17 Including our patient, an additional 15 cases treated with chemotherapy have been reported. 2,10,11,14,[18][19][20][21][22][23][24] In these more recent reports, CHOP was the standard treatment. Eight patients showed complete remission; one woman was disease free seven years after treatment.…”

“…Eight patients showed complete remission; one woman was disease free seven years after treatment. 14,[18][19][20][21][22] Seven patients responded with partial remission, however, one of these patients relapsed and died nine months after treatment. 2,10,12,23,24 In most patients who showed benefit from chemotherapy, there was either improvement in the tenderness and elevation of skin lesions or complete resolution of the initial cutaneous findings.…”

Cutaneous Hematopathology

“…From a clinical perspective, the variably livedoid erythema can generate differential considerations for vasculopathic states or reactive erythemas Ponzoni et al 2007 ). The indurated plaques and nodules can be confused with panniculitis (Kiyohara et al 2000 ) or with other neoplasms. The polymorphous cutaneous presentations of intravascular lymphoma have led to varied clinical impressions ranging from cellulitis (Roglin and Boer 2007 ) to vasculitis to vascular tumors (e.g., Kaposi's sarcoma) (Demirer et al 1994 ) to keratinocytic tumors (e.g., squamous cell carcinoma) (Stroup et al 1990 ).…”