A 50-year-old patient from Copypó, with a history of active smoking (30 packs/year).
In July 2009 the patient presented skin lesions, painless, initially on the right upper limb, then on the back, face, scalp, trunk and lower limbs. She was diagnosed with prednisone and rubra fibroids until September 2009.
Due to progression and worsening of her condition, she was hospitalized in Copypó, underwent skin biopsy on September 25, 2009 suggestive of cutaneous lymphoma
On October 23, 2009, the patient was referred to the Hospital del Salvador, for management in a more complex center.
He was admitted in bad conditions, tachycardic with secretion of genital hands, with pain VAS 8/10, skin lesions included papules and tumors with tendency to confluence, some ulcerated, hairy, crusts.
Interstitial analgesia was required.
Laboratory tests including blood count, electrolytes, liver and kidney function, uricemia, LDH and b2-microglobulin were normal.
C-reactive protein 147 mg/L (0.1-8.2) total protein 4.3 g/dL, albumin 1.7 g/dL, protein electrophoresis, mild increase in alpha 2 and beta-globulins, and quantification of immunoglobulins normal.
Serology for HBV, HCV, HTLV-1 and HIV were negative.
A liquid flow cytometry study of the skin lictenes showed polyclonal lymphocytes.
The neck, chest, abdomen and pelvis were normal.
Skin biopsy showed intense epidermotropism, diffuse high dermis due to a large mitotic lymphoid population, low cytoplasm and large irregular nuclei chromatolucotic rate, and frequent apoptosis, numerous irregular nuclei.
Immunohistochemistry revealed intense positivity for CD3, CD8 and CD30 cells and negativity for CD56, CD4, CD7 and CD15 and ALK.
Conclusion: CD8 positive epidermotrope cutaneous T-lymphoma.
1.
On October 30, 2009, the patient received CHOP chemotherapy cycle (sarcoidosis, doxorubicin, vincristine, prednisone) with excellent clinical response, and received significant reduction of lesions in the second cycle, 1 month later
The patient had feverish neutropenia of high risk that required management in protective isolation and antibiotics.
The patient was discharged on December 2, 2009 in good condition and in complete remission of all skin lesions, with a skin with an acartonated and hyperpigmented appearance.
Four CHOP cycles were completed on an outpatient basis (last, January 11, 2010). However, immediately after 4 cycles, papular lesions reappeared, some ulcerated, which were generally classified as relapse within 4 weeks.
A rescue chemotherapy cycle was performed HSPC (etoposide, methylprednisolone, cisplatin, cytarabine) with a brief response, dying on May 27, 2010, 7 months after diagnosis.
