Abstract

Erythroderma is a severe and potentially life-threatening condition which presents as widespread erythema and exfoliation involving greater than 80% of the body’s surface area. There is a wide array of etiologies that can lead to erythroderma. Moreover, histological features to distinguish between said etiologies can be nonspecific, making diagnosis a challenge for both the pathologist and clinician.  

Here we describe two patients with a similar presentation of intractable exfoliative erythroderma and exhaustive workup, who upon biopsy, had a mixed pattern dermatosis with an interface component. This prompted a concern for possible connective tissue disease and an autoimmune workup, which revealed positive ANA. In one case, a 51-year-old male was later found to have marginal zone lymphoma, and in another a 54-year-old female was found to have stage IV breast carcinoma.

To summarize, both the dermatopathologist and dermatologist should keep in mind that erythroderma could be the presenting symptom of malignancy. Additionally, if histology and an autoimmune panel is suggestive of a connective tissue disease but the clinical presentation is not congruent, a thorough workup to exclude malignancy is vital.