PMC10214040_01
Generalized erythematous maculopapular cutaneous eruption (flat, pink, nontender)
observed on both (A) legs, (B) palms, and (C) chest and face, with anasarca.
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Her karyotype analysis showed 47, XX, add(4)(q35), +8, inv(14)(q11.2q32), add(20)(P13).   Gross cytomorphologic review showed marked lymphocytosis with prominent cytologic atypia (Figure 1(A) and (B)). On physical examination, the rash was noted to involve her entire body including the trunk, extremities, and face, with edema of the bilateral lower extremities (Figure 1(A)-(C)).
Many medium-sized lymphoid cells with moderately condensed chromatin and prominent
nucleolus were seen in the peripheral smear - suggestive of a lymhpoid malignancy.
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A peripheral blood smear revealed numerous atypical lymphocytes, normochromic, with round nuclei and prominent nucleoli as shown in Figure 2(A) and (B). PCP (pneumocystis carinii pneumonia) prophylaxis with valganciclovir and Bactrim. Peripheral blood smear showed the same morphology as Figure 2, and flow cytometry showed the same clone of CD4/CD3+/CD7+ T-cells:findings compatible with persistent disease.
Atypical perivascular T-cell infiltrates (A) and were positive for CD3, CD4, CD5, and
CD7 and negative for CD8, CD30, and CD56 (B) consistent with cutaneous involvements by
the diagnosis of T-prolymphocytic leukemia (T-PLL).
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Skin biopsy that was taken around her time of admission was positive for atypical perivascular lymphocytic infiltrate, with CD7+, CD2+, CD3+, CD4+, and CD5+, and negative for CD8, CD30, and CD56 (Figure 3(A) and (B)).