SHM Converge Scientific Abstract ePoster Gallery-Atypical Cutaneous Presentation of Double-Hit, Large B-Cell Lymphoma Mimicking Sweet Syndrome: A Diagnostic Pitfall for Hospitalists.

Atypical Cutaneous Presentation of Double-Hit, Large B-Cell Lymphoma Mimicking Sweet Syndrome: A Diagnostic Pitfall for Hospitalists.

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This case describes a 91-year-old man with dementia and other comorbidities who presented after an unwitnessed fall and was initially treated for presumed catheter-associated urinary tract infection and metabolic encephalopathy. Two weeks before admission, he had progressive cognitive decline, hallucinations, and an erythematous maculopapular rash on the chest. During hospitalization, he developed severe sepsis-like illness with negative cultures, pyelonephritis, bilateral pleural effusions, and treatment-resistant, PTH-independent hypercalcemia, raising concern for an occult malignancy. His rapidly progressive rash initially mimicked Sweet syndrome, prompting skin biopsy.<br /><br />Biopsy showed dermal infiltration by atypical B cells with a high proliferative index (Ki-67 90%). Immunohistochemistry was positive for CD20, CD10, c-MYC, and BCL2. Fluorescence in situ hybridization confirmed rearrangements in MYC and BCL2, establishing the diagnosis of double-hit high-grade B-cell lymphoma (HGBL-MYC/BCL2). Despite escalation of care, the patient’s condition deteriorated quickly, and he died within two weeks of admission.<br /><br />The report emphasizes that cutaneous involvement in HGBL is rare but important because it may present as a rapidly spreading rash with systemic symptoms, leading to early biopsy. It must be distinguished from primary cutaneous lymphomas, which usually follow a more indolent course and are often managed with localized treatments. In contrast, skin involvement in systemic HGBL indicates disseminated disease and a poor prognosis. Emerging therapies such as CAR-T cells, bispecific antibodies, and BCL2-targeted agents like venetoclax may offer benefit, but options remain limited in very elderly patients.

Asset Subtitle

Aisha Adigun

Meta Tag

Author List Aisha Adigun, Nadine Vidor, Sai Venkat Aluri, Saurav Das, Yifei Zhang

Category Clinical Vignettes

Concept High-Grade B-Cell Lymphoma

Concept Skin involvement

Concept Double-Hit Lymphoma

Concept Systemic Lymphoma

Concept Primary Cutaneous Lymphoma

Distinguished Non-Finalist

Presenter Organization CIFC Health/Griffin Hospital

Presenting Author Aisha Adigun

Track Adult

Keywords

high-grade B-cell lymphoma

double-hit lymphoma

cutaneous lymphoma

skin biopsy

MYC rearrangement

BCL2 rearrangement

rapidly progressive rash

hypercalcemia

dementia

sepsis-like illness

High-Grade B-Cell Lymphoma

Skin involvement

Double-Hit Lymphoma

Systemic Lymphoma

Primary Cutaneous Lymphoma