Keratoderma-Like T-Cell Dyscrasia: A Case Report.

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Cutaneous T-cell dyscrasia (CTCD) is a diverse group of T-cell infiltrates, often clonal and epitheliotropic.
• The exact cause of CTCD is unknown, but some medications, like statins, are suspected to trigger cutaneous T-cell lymphocytic infiltrates.

Observation:

• A patient presented with a persistent, itchy, scaly rash on palms and soles resistant to topical steroids.
• Histopathology showed mild lymphocytic infiltrate with atypical lymphocytes and exocytosis.
• Immunophenotyping revealed a CD3+ T-cell predominance with a normal CD4/CD8 ratio and reduced CD7 expression.

Findings:

• The clinical, histopathological, and immunophenotypic findings supported a diagnosis of statin-induced CTCD.
• Discontinuation of statin medication resulted in complete resolution of the patient's symptoms.

Implications:

• This case underscores the significance of a thorough medication history in diagnosing CTCD.
• Drug-induced T-cell dyscrasia is potentially reversible upon withdrawal of the causative agent, unlike classic CTCD presentations.
• Early identification and drug cessation can prevent disease progression and improve patient outcomes.