A Case of Cutaneous T-cell Lymphoma with Total Nail Dystrophy / 대한피부과학회지

ABSTRACT

We report a case of cutaneous T-cell lymphoma in a 40-year-old man. He has suffered from generalized pruritus for 10 years. Seven months ago, multiple nodules developed over the scalp, face, and thigh. The physical examination showed thickened dystrophic twenty nails with brownish discoloration and lichenified, eczematoid lesions over the trunk and extremities. The skin biopsy revealed diffuse, extensive infiltrates of atypical lymphoid cells in the dermis, which appeared as T lymphocytes by immuno-histochemistry; approximately 90% of the tumor cells were CD3-positive, 80% were CD4-positive, and 60% CD45RO-positive. Laboratory analyses in the peripheral bload showed 18% atypical lymphocytes (Sezary cell), an elevated LDH(746 U/liter), and abnormal lymphocyte subset proportions(ratio of Th/Ts is 4.08). A bone marrow puncture revealed the infiltrations of lymphoid cells and computed tamo-graphy showed no evidence of other organ involvement except the swelling of bilateral inguinal lymph nodes. Spontaneous partial regression of the tumors ensued on the way of oral antihistamines and topical corticosteroids for the relief of the pruritus. The tumorous skin lesions and onychodystrophy disappeared completely with 6 cycles of systemic chemotherapy of CHOP(cyclophosphamide, doxoru-bicin, vincristine, and prednisone).