PMC3065054_01
Cutaneous lesions on the thigh, which had been present for 8 months with recent worsening in severity.
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The rash showed multiple areas of activity and remission presenting as spreading rings (Figure 1).
Biopsy of soft tissue from the left thigh revealed: (a) at 10x magnification shows lymphoid infiltrate with pattern resembling lobular and septal panniculitis, and (b) at 40x magnification shows lymphoid infiltrate with abundant cytoplasm. At 100x magnification with oil-immersion biopsy showed (c) atypical lymphoid cells with atypical and irregular nuclei as well as numerous fat cells, (d) numerous single-cell necroses and atypical lymphoid infiltrate, (e) mitotic figure in the center with areas of necrosis and fibrosis, (f) mitotic figure with scattered histiocytes and area of necrosis, and (g) area of necrotic debris.
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On low-power field, results for the left groin area sample showed extranodal fibroadipose tissue containing a lymphoid infiltrate with a pattern similar to lobular and septal panniculitis (at 10x magnification) (Figure 2(a)). On high-power field (Figures 2(b)-2(g)), the lymphoid cells were markedly atypical with irregular nuclei. CD8 but negative for CD4 and CD56 (Figure 2). CD4 was positive in scattered small lymphocytes and frequent interspersed histiocytes. CD20 was positive in rare, scattered B-cells.
Cutaneous lesions after treatment with five cycles of CHOP chemotherapy (Five months after second admission).
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CHOP therapy (Figure 3). CSSSI was successfully treated with 4 weeks of IV daptomycin and rifampin.