case_images: PMC3039764_01
case_images: A: A flower-like nucleated T cell in the peripheral blood smear from the patient. B: Pathology of marrow biopsy revealed lymphomatous involvement in marrow space. C, D: Crusted scaly lesions at the scalp and posterior auricular skin fold (arrow). E: Microscopic examination of a scraping scale shows two hatched eggs (right) and a mite (left) (KOH, x400).
case_images: UPS-0300-9734-116-077_g001.jpg
case_images: PMC3039764_01_UPS-0300-9734-116-077_g001.jpg
case_images: F1
case_images: Examination of her peripheral blood morphology disclosed abnormal lymphoid cells with flower-shaped nuclei (Figure 1A), and a subsequent serology testing for human T-cell lymphotropic virus 1 (HTLV-1) antibody showed a positive result. A bone-marrow biopsy specimen demonstrated marrow infiltration of atypical lymphoid cells (Figure 1B), around 20%-30%, which were immunoreactive for UCHL-1, CD3, and CD7, but non-immunoreactive for CD20, CD34, TdT, and myeloperoxidase. Moreover, she presented with scaly crusted skin lesions over the scalp (Figure 1C) and external ears (Figure 1D), which were initially considered as skin involvement of ATL. However, microscopic examination of the scraping scales with potassium hydroxide staining disclosed many scabies mites and hatched eggs (Figure 1E).