Abstract

A 91-year-old woman presented with an 8-month history of nonhealing left lower extremity ulcers. A prior biopsy was interpreted as most consistent with venous stasis dermatitis, and the patient’s ulcers had been treated with debridement, topical steroids, and general wound care. Despite treatment, her ulcers progressed, and she was placed on an oral steroid taper with initial improvement; however, with rapid worsening when discontinued. The left leg was edematous, and the ulcers had thick, yellow, fibrinous bases, irregular sloping edges, and surrounding violaceous erythema. Subtle subcutaneous nodules were palpable adjacent to the ulcers. Biopsy of a nodule demonstrated subcutaneous infiltrates of markedly atypical lymphoid cells with hyperchromatic, pleomorphic nuclei that rimmed adipocytes. Immunohistochemical studies demonstrated that the atypical lymphoid cells were weakly positive for CD8 and expressed CD2, CD3, CD5, TIA-1, granzyme-B, and T-cell receptor (TCR) beta. They were negative for CD4, CD7, TCR delta, CD20, CD56, and CD163. The patient was diagnosed with subcutaneous panniculitis-like T-cell lymphoma (SPTCL). Laboratory testing was notable for elevated lactate dehydrogenase (262 U/L). She was started on oral prednisone and referred to radiation oncology and hematology oncology for further management. A PET-CT performed while the patient was on prednisone showed soft tissue stranding with increased uptake restricted to the medial left lower leg. In the interim, she has been treated with radiation therapy with good effect. This case highlights that SPTCL may rarely present with ulceration and may mimic venous stasis ulcers.

Financial Disclosure:
No current or relevant financial relationships exist.