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A malignant itch.

Kam-lun Ellis Hon1, Man-chin Adrian Lam, Ting-fan Leung

  • 1Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. ehon@cuhk.edu.hk

Journal of the National Medical Association
|January 18, 2007
PubMed
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A three-year-old girl experienced severe, unexplained itch, later diagnosed as peripheral T-cell lymphoma. This case highlights the importance of considering malignancy in pediatric patients with intractable pruritus.

Area of Science:

  • Pediatric Oncology
  • Dermatology
  • Clinical Case Reports

Background:

  • Intractable pruritus can be a challenging symptom in pediatric patients.
  • Unexplained itch in children often leads to misdiagnosis and delayed treatment.

Observation:

  • A previously healthy three-year-old girl presented with a four-week history of intense, generalized itch.
  • Despite extensive dermatological consultations and treatments for presumed scabies and eczema, her symptoms persisted.
  • The patient later developed hip pain and fever, prompting further investigation.

Findings:

  • Radiological and histopathological examinations revealed peripheral T-cell lymphoma.
  • Chemotherapy led to a significant reduction in the patient's nocturnal itch, as monitored by a DigiTrac device.

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  • The itch pattern differed from atopic dermatitis, characterized by high-intensity, low-frequency scratching.

    • Implications:

    • This case represents the first reported instance of intractable pruritus associated with peripheral T-cell lymphoma in a child.
    • Clinicians should consider underlying malignancies, including lymphoma, in the differential diagnosis of unexplained generalized itch in pediatric patients.
    • Early consideration of systemic disease can prevent diagnostic delays and improve patient outcomes.