Granuloma annulare-like skin lesions as an initial manifestation in a Japanese patient with adult T-cell leukemia/lymphoma
Granuloma annulare-like skin lesions as an initial manifestation in a Japanese patient with adult T-cell leukemia/lymphoma
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DOI：
10.1016/j.jaad.2008.11.014
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发表时间：
2009-05-01
影响因子：
13.8
通讯作者：
Soma, Yoshinao
中科院分区：
文献类型：
--
作者：
Kawakami, Tamihiro;Kawanabe, Takeshi;Soma, Yoshinao
环状肉芽肿以非干酪性真皮肉芽肿为特征，伴有结缔组织改变。在某些情况下，可能与血液系统和实体恶性肿瘤有关。我们描述了一位70岁的男性患者，他的肘部、上肢和手腕上有红斑状环形斑块长达3个月。组织学检查显示真皮内有上皮样细胞肉芽肿伴密集的异型淋巴细胞。皮肤标本免疫组织化学染色显示CD3(+)、CD4(+)、CD5(+)和CD25(+)细胞明显浸润。用Southern杂交和聚合酶链式反应检测血液和脑脊液中人T细胞白血病病毒I型前病毒DNA。根据最初的皮肤表现，患者被诊断为成人T细胞白血病/淋巴瘤。他的病情发展迅速，导致了他的死亡。本病例的环状肉芽肿样皮肤病变可能是宿主对肿瘤细胞或持久性人类T细胞白血病病毒I型病毒抗原的一种特殊的免疫超敏反应。皮肤科医生应该意识到，这种皮肤状况可能是成人T细胞白血病/淋巴瘤的初始表现。(《美国皮肤病杂志》2009；60：848-52。)
Granuloma annulare is characterized by noncaseating dermal granulomas with connective tissue changes. A relationship with hematologic and solid malignancies has been suggested in some cases. We describe a 70-year-old man who had erythematous annular plaques on his elbows, upper extremities, and wrists for a period of 3 months. Histologic examination revealed epithelioid cell granulomas associated with dense atypical lymphocytes in the dermis. Immunohistochemical staining of skin specimens showed a prominent infiltration of CD3(+), CD4(+), CD5(+), and CD25(+) cells. Human T-cell leukemia virus type I proviral DNA was detected in the blood and cerebrospinal fluid by Southern blot analysis and polymerase chain reaction assay. The patient was given the diagnosis of adult T-cell leukemia/lymphoma based on the initial cutaneous manifestations. His condition progressed rapidly and led to his death. The granuloma annulare-like skin lesions in our patient could be considered as a peculiar immunologic hypersensitivity reaction of the host against the tumor cells or persistent human T-cell leukemia virus type I viral antigens. Dermatologists should be aware that this skin condition may be an initial manifestation of adult T-cell leukemia/lymphoma. (J Am Acad Dermatol 2009;60:848-52.)