Subcutaneous nodules as initial presentation of Burkitt lymphoma in HIV-negative child

Burkitt lymphoma (BL), an aggressive non-Hodgkin lymphoma, usually presents with large extranodal masses involving jaw bones, intestines and central nervous system. There are 3 main types of BL: endemic, sporadic, and immunodeficiency variant. Although each variant frequently involves extranodal site, cutaneous involvement is distinctly rare. Most of the previously reported cases with cutaneous involvement occurred at relapse, or in an immunocompromised host. The mode of spread may be direct extension or hematogenous spread. We report a 17-year-old boy who presented with multiple large subcutaneous nodules as initial manifestation of BL that may have been due to hematogenous spread.