SHM Converge Scientific Abstract ePoster Gallery-Fever, Rash, and a Rare Lymphoma

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This document describes a rare case of <strong>subcutaneous panniculitis-like T-cell lymphoma (SPTCL)</strong>, a cutaneous non-Hodgkin lymphoma that can closely mimic benign inflammatory conditions such as panniculitis, erythema nodosum, or lupus.

A <strong>42-year-old woman</strong> presented with <strong>fever, facial swelling, anemia, leukopenia, and months of painless skin lesions</strong> on her extremities and trunk. Her illness had been misdiagnosed several times over six months, including as erythema nodosum and possible coccidioidomycosis, and she received treatments such as prednisone, rifampin, and fluconazole without improvement.

On evaluation, she was febrile and tachycardic, with <strong>indurated erythematous patches</strong> on the legs and torso. Laboratory studies showed <strong>anemia, neutropenia, elevated inflammatory markers, high ferritin, and elevated LDH</strong>. Extensive infectious and rheumatologic testing was negative. PET imaging revealed <strong>diffuse hypermetabolic subcutaneous infiltrates</strong>, supporting a systemic inflammatory or malignant process.

Definitive diagnosis came from <strong>skin biopsy and immunohistochemistry</strong>. Pathology showed lymphoid infiltrates in the dermis and fat with <strong>rimming of adipocytes by atypical lymphocytes</strong>, along with histiocytes phagocytizing apoptotic cells. The cells were <strong>CD3+, CD5+, CD8+, and TIA+</strong>, findings consistent with <strong>SPTCL</strong> and not supportive of lupus panniculitis or other alternatives.

The key message is that SPTCL is <strong>rare, difficult to diagnose, and often mistaken for other diseases</strong>. Because diagnosis depends on tissue biopsy and specialized staining, clinicians should maintain suspicion when patients have persistent painless subcutaneous plaques or nodules with systemic symptoms. A <strong>multidisciplinary approach</strong> involving hospital medicine, dermatology, hematology, and pathology is essential for timely diagnosis and treatment.

Asset Subtitle

Katherine Frishe

Meta Tag

Author List Alex Rosenberg, Anya Joyo, Ethan Pritikin, Hye Yi, Karen Haiber, Katherine Frishe, Varun Roy

Category Clinical Vignettes

Concept Subcutaneous Panniculitis-like T-cell Lymphoma

Concept Skin Biopsy

Concept Immunohistochemistry

Concept Adipocyte Rimming

Concept Subcutaneous Plaque

Distinguished Non-Finalist

Presenter Organization LAC + USC Medical Center

Presenting Author Katherine Frishe

Track Adult

Keywords

subcutaneous panniculitis-like T-cell lymphoma

SPTCL

skin biopsy

immunohistochemistry

panniculitis

erythematous patches

hypermetabolic subcutaneous infiltrates

CD3 CD5 CD8 TIA positive

rare lymphoma

multidisciplinary diagnosis

Subcutaneous Panniculitis-like T-cell Lymphoma

Skin Biopsy

Immunohistochemistry

Adipocyte Rimming

Subcutaneous Plaque