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

T-cell acute lymphoblastic lymphoma-leukemia (T-ALL) is a rare neoplastic disease with presenting symptoms that are often non-specific. As such, accurate diagnosis requires high clinical suspicion and assessment of bone marrow aspirate with flow cytometry and morphology. While remission is achievable in most patients, the five-year survival rate is only 48% despite treatment. The standard chemotherapy regimen is referred to as hyper-CVAD, where CVAD stands for cyclophosphamide, vincristine sulfate, Adriamycin (doxorubicin), methotrexate, and dexamethasone. In this study, we describe a 38-year-old female who presented with atraumatic abdominal bruising and a petechial rash on the upper and lower extremities. Imaging revealed a 16 cm anterior mediastinal mass and a bone marrow and mediastinal mass biopsy confirmed a diagnosis of T-ALL. The patient received hyper-CVAD cycle 1A with several complications but ultimately achieved remission after four cycles. Here, we stress the importance of broadening differentials for new-onset petechial rashes in adults to include systematic lymphomas, such as T-ALL, and the need for early recognition so patients can receive timely treatment.