SHM Converge Scientific Abstract ePoster Gallery-"A Fluid Filled" Presentation of Lymphoma

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A 69-year-old man with no significant prior medical history developed a 6-week history of progressively worsening painful mucocutaneous lesions involving the oral cavity, face, scalp, trunk, extremities, and groin. Initially treated as a fungal infection, his condition rapidly worsened with severe oral erosions, bullous skin lesions, constipation, 30-pound weight loss, lethargy, and malaise. Imaging of the abdomen and pelvis showed an 18-cm retroperitoneal mass, retroperitoneal lymphadenopathy, left hydronephrosis, and a left pleural effusion.<br /><br />Biopsy of a skin lesion showed suprabasilar acantholysis, and pleural fluid cytology revealed high-grade B-cell lymphoma. Biopsy of the retroperitoneal mass confirmed follicular lymphoma. Based on the clinical picture and pathology, the patient was diagnosed with paraneoplastic pemphigus (PNP) associated with lymphoma. He was treated with high-dose intravenous corticosteroids followed by urgent R-CHOP chemotherapy, which stabilized his condition.<br /><br />PNP is a rare and often fatal mucocutaneous autoimmune syndrome most commonly linked to an underlying untreated lymphoproliferative disorder. It accounts for 3–5% of pemphigus cases and carries a high mortality rate, largely due to severe mucosal disease and potential respiratory involvement such as bronchiolitis obliterans. The hallmark feature is severe erosive stomatitis, often accompanied by polymorphic skin findings including erosions, bullae, erythema, and scaly plaques. Diagnosis relies on clinical presentation, histopathology, immunofluorescence, and/or immunoprecipitation.<br /><br />This case highlights the importance of recognizing progressive painful mucocutaneous disease as a possible manifestation of occult malignancy, emphasizing the need for early diagnosis and prompt treatment of the underlying cancer.

Asset Subtitle

Kevin C. Eaton

Meta Tag

Author List Kevin C. Eaton, Neha Verma, Phillip Jules

Category Clinical Vignettes

Concept Paraneoplastic Pemphigus

Concept Erosive Stomatitis

Concept Lymphoproliferative Malignancy

Concept Lymphoma

Concept Malignancy

Distinguished Non-Finalist

Presenter Organization Moffitt Cancer Center

Presenting Author Kevin C. Eaton

Track Adult

Keywords

paraneoplastic pemphigus

follicular lymphoma

high-grade B-cell lymphoma

mucocutaneous lesions

oral erosions

suprabasilar acantholysis

retroperitoneal mass

R-CHOP chemotherapy

bullous skin lesions

bronchiolitis obliterans

Paraneoplastic Pemphigus

Erosive Stomatitis

Lymphoproliferative Malignancy

Lymphoma

Malignancy