Primary Cutaneous Acral CD8⁺ T-cell Lymphoma Induced by Persistent Delayed Hypersensitivity to Gold Earrings

Primary cutaneous CD8⁺ T-cell lymphoma has been included as a provisional entity within the new revised classification of lymphoid neoplasms of the World Health Organization in 2016¹. It was initially described as indolent CD8⁺ lymphoid proliferation of the ear² and a total of 29 cases of such neoplasm have been published in the literature so far. None of them have been linked to delayed contact hypersensitivity reactions. We present a case of acral type primary cutaneous lymphoma T CD8⁺ involving both earlobes clearly related with the prolonged use of gold earrings, confirmed with epicutaneous tests, histopathology, immunohistochemical and molecular studies. Auricular skin lesions were induced again with a provocation test with identical histopathologycal and the same clonality, confirming both the diagnosis of lymphoma and its induction by the antigenic stimulus of gold.