2024 Volume 39 Issue 3 Pages 299-305
In December 2022, a 68－year－old woman presented with erythroderma. Seven years earlier, itchy erythematous lesions had developed on the trunk and extremities. Blood tests revealed a white blood cell count of 7,670/µL (eosinophils : 8.7%), soluble interleukin－2 receptor at 2,030 U/mL, and lactate dehydrogenase at 168 U/L. No abnormal lymphocytes or anti－HTLV－1 antibodies were detected in the peripheral blood. Histopathological examination of the erythema revealed the infiltration of CD3 + T lymphocytes into the superficial dermis with epidermotropism. Infiltrating abnormal lymphocytes in the epidermis predominantly expressed CD4. T－cell clonality was confirmed by PCR－based T－cell receptor gene rearrangement testing. She was diagnosed with erythrodermic mycosis fungoides and initially treated with topical steroids, oral etretinate, and prednisolone. Positron emission tomography revealed inguinal and external iliac lymphadenopathy with significant FDG accumulation. Biopsy of the left inguinal lymph node revealed infiltration of CD30－ and CD15－positive large cells, suggesting the presence of Hodgkin and Reed-Sternberg cells. The swollen lymph nodes were diagnosed as nodular sclerosis and classical Hodgkin’s lymphoma. Brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A－AVD) therapy was initiated but stopped after three courses owing to severe adverse events. Nevertheless, the patient exhibited complete remission of Hodgkin lymphoma and a marked improvement in erythroderma.[Skin Cancer (Japan) 2024 ; 39 : 299－305]
