PMC3175357_01
The patient presented skin infiltration of 90% of the total body surface (left), with palmoplantar keratoderma (right).
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F1
After 4 years of bexarotene treatment during which clinical response was maintained, the patient experienced a relapse with skin infiltration of 90% of the total body surface (fig. 1, left), with palmoplantar keratoderma (fig. 1, right) and palpable axillary and inguinal lymph nodes.
Skin biopsy showing CTCL without large-cell transformation (left, HE, x200) and CD25 expression (center, HE, x400), and lymph node biopsy revealing extensive infiltration of atypical lymphocytes (right, HE, x200).
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F2
A skin biopsy confirmed the diagnosis of CTCL without large-cell transformation (fig. 2, left). In addition, 20% of the atypical lymphocytes were positive for CD25 expression by immunohistochemistry (fig. 2, center). The histological examination of the lymph node biopsy showed extensive infiltration (fig. 2, right).
After combined treatment with bexarotene and denileukin diftitox, the skin lesions improved partially.
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F3
Skin lesions improved partially (fig. 3), and lymphadenopathy was reduced and finally disappeared.