PMC10166224_01
Scattered pustules and papules in the scalp.
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Punch biopsy was performed from the border of the ulcers on the finger, scalp [Fig. 1], and upper thigh.
Thigh Punch Biopsy:. H&E shows subepidermal vesicular dermatitis with atypical lymphoid infiltrate (A. 100x, B. 400x). The atypical lymphocytes are CD3 and CD4-positive T-cells (C and D, in order) with CD7 downregulation (E).
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Immunostaining for these atypical cells showed positivity for CD2, CD3, CD5, CD25, and negative ALK1, CD8, CD20, CD34 [Fig. 2A-E].
PET/CT showing diffuse metabolic activity in the spleen (Panel 1), lungs (Panel 2), and the scalp (Panel 3).
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Imaging done for the sake of diagnosis, including positron emission tomography-computed tomography (PET/CT) scan showed extensive organ-system lymphomatous involvement in lungs, spleen, kidneys, diaphragm, and scalp with multi-level lymphadenopathy including axillary/chest wall, retroperitoneal, pelvic, and cervical chains [Fig. 3].