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Case Reports

Abstract

Eosinophilic annular erythema (EAE) is a rare inflammatory dermatosis characterized by annular plaques and a dermal infiltrate rich in eosinophils. While often considered idiopathic or reactive, it can occasionally signal an underlying systemic disease. We present a 54-year-old woman with a recurrent, pruritic annular eruption on the trunk and extremities. An initial skin biopsy showed superficial and deep perivascular dermatitis with eosinophils and focal vasculitis changes, consistent with EAE. Despite corticosteroid therapy, the eruption persisted. A second biopsy, approximately one month later, revealed an atypical angiocentric lymphoid infiltration. Concurrently, peripheral blood flow cytometry identified an aberrant CD4+CD10+ T-cell population, and lymph node biopsy confirmed nodal T-follicular helper cell lymphoma, angioimmunoblastic type (nTFHL-AI). The atypical cutaneous lymphoid infiltrate had morphologic features similar to the nodal lymphoma. This case highlights the importance of considering a paraneoplastic process in persistent or treatment-resistant eosinophilic dermatoses. Atypical histologic findings, systemic symptoms, or disease recurrence should prompt further investigation. Dermatopathologists play a key role in recognizing subtle cutaneous manifestations of systemic lymphoproliferative disorders.