A 24-year-old patient with a history of congenital left amaurosis presented with erythematous, diffuse erythematous skin lesions on the scalp, non-specific anemia of the scalp and thorax.
Skin biopsy was reported as small and medium-cell non-Hodgkin's T-cell lymphoma, with nodular diffuse pattern, and CD4 expression in 90% of tumor cells.
A dissemination study showed absence of lymph nodes in computed axial tomography of the chest, abdomen and pelvis and bone marrow in biopsy.
Chemotherapy cycles of CHOP were planned for 8 patients with neutropenia, doxorubicin, vincristine, and prednisone, of which only 6 could be performed due to poor tolerance and persistent headache in all cycles vomiting and prednisone.
The patient presented complete resolution of skin lesions and bone marrow involvement in the biopsy, so it was declared in complete remission.
Brain magnetic resonance imaging was performed due to persistent headache and vomiting, which showed no lesions.
Cerebrospinal fluid (CSF) analysis showed hyperproteinorrhea and increased cellularity, while immunophenotype was reported as suggestive of central nervous system failure by NCDPB.
Rescue therapy was planned with intrathecal methotrexate plus high-dose cytarabine, presenting as complication two episodes of high-risk febrile neutropenia without microbiological isolation, which were treated with associated antibiotic therapy and favorable outcome.
Initial negativization of CSF was achieved in the immunophenotype, but later persistence of pathological cells was confirmed.
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Twelve weeks after starting rescue chemotherapy, the patient presented pain in the left glue radiating to the thigh and lumbar area.
Magnetic resonance imaging of the dorsolumbar spine showed underlying disease in multiple vertebral bodies, sacral and iliac left bones.
He was considered a non-candidate for central nervous system radiotherapy due to the diffuse nature of the disease and conservative management was decided. He died 2 months later.
