PMC10056216_01
The patient's clinical evaluation and treatments. (A) Pemphigus lesions on the skin and lip were extremely severe before treatment. A lymph node biopsy revealed (B) small B-cell lymphoma (magnification, x400). Positive immunohistochemical results were observed for (C) CD5 (magnification, x400), (D) CD20 (magnification, x400), and (E) CD23 (magnification, x400). Skin biopsy specimens demonstrating intraepidermal vesicle [(F) (magnification, x200)]. During the treatment of the relapse period, the patient developed shortness of breath and wheezing. (G) At the onset of bronchiolitis obliterans, high-resolution computed tomography revealed hyperinflation and bronchial wall thickening in bilateral lungs. (H) After treatment, the bronchial wall thickening was alleviated. (I) Currently, the skin lesions are healing and the patient is in relatively good health (J).
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A slight erosion of the anus was also detected (Figure 1A). The pathological findings suggested that the patient had small lymphocytic lymphoma (SLL; Figures 1B-E). Since this patient presented with severe oral mucosal ulceration and skin lesions, we performed a skin biopsy (Figures 1F,G). A CT scan of the lungs revealed bronchitis (Figure 1H). He recovered well after that with ibrutinib maintenance therapy (Figure 1I). He has been disease-free and has had a relatively high quality of life for 30 months (Figure 1J).