[Chronic prurigo revealing an angioimmunoblastic T cell lymphoma]

Cutaneous manifestations in angio-immunoblastic T cell lymphoma (AITL) can be seen in almost 50% of patients. They are especially represented by maculo-papular pseudotoxic exanthema. The other manifestations, like nodular prurigo are rarely observed. We report a case of AITL diagnosed after an etiologic screening for chronic prurigo.

The objective of our work is to stress on the possibility to diagnose a hemopathy in etiologic screening of chronic pruritus.

A 45-year-old patient presented a chronic pruritus of 18 months associated with general manifestations (fever, night sweating and weight loss). Physical examination showed diffuse adenomegalies. On histology, the lymph nodes were composed of polymorphous lymphoid proliferation made of middle to large sized cells with clusters of epithelioid cells and post-capillary veinules hyperplasia. Immunohistochemical study showed T cell phenotype (CD3+). Large cells were CD30+. Latent Protein of EBV virus was not expressed. Molecular biological analysis of a lymph node showed a T cell clonal proliferation. Cutaneous biopsy showed a little dermic perivascular lymphocytic inflammatory infiltrate. The diagnosis of angio-immunoblastic T cell lymphoma was made. The abdomino-pelvian CT scanner showed multiple inter-aortico-cave lymph nodes and a splenomegaly. A polychemotherapy was initiated.

In front of chronic prurigo with general manifestations, a careful etiologic screening should be done to detect internal disorders especially malignant hemopathies.