Necrotizing Granulomatous Dermatitis and Panniculitis Masquerading as T Cell Lymphoma

Area of Science:

• Dermatology
• Oncology
• Rheumatology

Background:

• A 51-year-old woman with a history of steroid-dependent ulcerative colitis, rheumatoid arthritis, and diabetes mellitus presented with concerning skin lesions.
• The patient developed painful, erythematous subcutaneous nodules on her thighs, accompanied by fever.

Observation:

• Initial histopathology suggested an abscess, but the lesions did not improve with broad-spectrum antibiotics.
• The nodules progressed to exhibit signs of necrosis, necessitating surgical debridement and hyperbaric oxygen therapy.

Findings:

• Molecular studies detected T cell receptor-beta (TCR-β) gene rearrangements.
• These findings, coupled with the clinical presentation and resistance to antibiotics, raised suspicion for a neoplastic process.

Implications:

• The patient was referred for further evaluation of possible subcutaneous panniculitis-like T cell lymphoma (SPTL).
• This case highlights the importance of considering rare hematologic malignancies in the differential diagnosis of refractory skin lesions.
• Early recognition and appropriate molecular diagnostics are crucial for managing SPTL.