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Adult-Onset T-Cell Acute Lymphoblastic Lymphoma-Leukemia Presenting With Petechial Rash: A Case Report.

Kelly Kimball¹, Vissy Elad², Edward J Hamad²

¹Internal Medicine, OhioHealth Riverside Methodist Hospital, Columbus, USA.

|September 25, 2024

Summary

T-cell acute lymphoblastic lymphoma-leukemia (T-ALL) is a rare cancer. Early recognition of non-specific symptoms like bruising is crucial for timely treatment and improved outcomes in adults.

Keywords:

chemotherapy dermatology oncology petechial rash t-cell lymphoma

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Area of Science:

Hematology
Oncology
Internal Medicine

Background:

T-cell acute lymphoblastic lymphoma-leukemia (T-ALL) is a rare neoplastic disease.
Diagnosis requires high clinical suspicion and specialized testing like bone marrow aspirate with flow cytometry and morphology.
The standard chemotherapy regimen is hyper-CVAD (cyclophosphamide, vincristine sulfate, Adriamycin, methotrexate, and dexamethasone).

Observation:

A 38-year-old female presented with atraumatic abdominal bruising and a petechial rash.
Imaging revealed a 16 cm anterior mediastinal mass.
Biopsies confirmed T-cell acute lymphoblastic lymphoma-leukemia.

Findings:

The patient received hyper-CVAD chemotherapy, experiencing complications.
Remission was ultimately achieved after four cycles of treatment.
This case highlights T-ALL as a differential diagnosis for adult petechial rashes.

Implications:

Broadening differential diagnoses for new-onset petechial rashes in adults to include systemic lymphomas like T-ALL is essential.
Early recognition and timely treatment of T-ALL can improve patient outcomes.
This case underscores the importance of prompt diagnosis and management of rare hematologic malignancies.