PMC4318027_01
Purpuric tinea corporis in patient 2 with acute adult T-cell leukemia/ lymphoma
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F1
A 32-year-old male with history of hypopigmented macules over chest and trunk of 1 year duration, presented with pruritic purpuric macules and plaques over face, trunk, and extremities and purpuric annular plaque over medial aspect of thighs of 20 days duration [Figure 1].
Wet purpura in patient 2 with acute ATL
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F2
Wet purpura was present over hard palate and buccal mucosa [Figure 2].
Peripheral smear of patient 2 showing atypical lymphoid cells with indented nuclei (hematoxylin and eosin stain (H and E), magnification 100x)
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F3
His total leukocyte count was elevated and peripheral smear revealed large number of atypical lymphocytes with cleaved nucleus [Figure 3] which were CD3+, CD5+, CD 25+, and CD7- by flow cytometry.
Skin biopsy showing dense lymphoid infiltrate in the dermis with epidermotropism in patient 2 (H and E, magnification x 10)
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F4
Dense infiltrate of medium sized atypical lymphocytes occupied the dermis with epidermotropism [Figure 4] in skin biopsy and similar infiltrate in lymph node biopsy which showed CD3+, CD4+, CD8-, and CD20- on immunohistochemistry.
Verrucous papules in patient 3 with acute ATL
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F5
On examination, there were multiple verrucous and crusted papules [Figure 5] and plaques over forearm, dorsum of right hand and legs, cervical and axillary lymph node enlargement, and hepatosplenomegaly.
Hypopigmented macules in patient 5 with smoldering ATL
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F6
A 30-year-old male with history of recurrent eczematous lesions in childhood presented with pruritic hypopigmented scaly macules [Figure 6] over back of 4 months duration.