Track: Case Reports

Abstract:

Background:

Reactive perforating collagenosis (RPC) is a rare subtype of acquired perforating dermatosis, histologically defined by transepithelial elimination of altered collagen bundles through the epidermis. While most frequently associated with chronic renal disease and diabetes mellitus, RPC has also been reported, albeit rarely, as a paraneoplastic phenomenon, particularly in association with hematologic malignancies such as Hodgkin lymphoma.

Case Description:

A 63-year-old male with well-controlled type 2 diabetes mellitus and a remote history of Stage IV marginal zone lymphoma presented with a four-month history of a pruritic eruption involving the trunk and extremities. Physical examination revealed scattered pink-violaceous papules with central keratotic plugs. Punch biopsies from the posterior upper arm and anterior thigh demonstrated centrally ulcerated epidermis with vertically oriented collagen bundles extending into an overlying crust, a dense neutrophilic infiltrate at the ulcer surface, and a mild perivascular lymphohistiocytic infiltrate in the adjacent dermis, confirming the diagnosis of RPC. Direct immunofluorescence revealed nonspecific findings. Soon after onset of the eruption, the patient developed new supraclavicular lymphadenopathy. Excisional biopsy revealed nodular sclerosing Stage III Hodgkin lymphoma. He initiated narrowband UVB phototherapy with significant dermatologic improvement and subsequently achieved complete remission following systemic therapy with nivolumab and doxorubicin/vinblastine/dacarbazine (AVD).

Conclusion:

This case represents the fifth reported instance of RPC as a paraneoplastic manifestation of Hodgkin lymphoma, underscoring the importance of considering the possibility of underlying malignancy in patients presenting with new-onset RPC.

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Kevin Severson