A Rare Case of Subcutaneous Panniculitis-Like T Cell Lymphoma with Hemophagocytic Lymphohistiocytosis Mimicking Cellulitis.

BACKGROUND Subcutaneous panniculitis-like T cell lymphoma and primary cutaneous γdelta T cell lymphoma are rare forms of non-Hodgkin lymphoma presenting as skin nodules or plaques. CASE REPORT Here, we present a case of a 48-year-old man with multiple subcutaneous, tender, erythematous nodules on his right thigh and left arm. Multiple courses of antibiotics were administered with no significant improvement in the patient's lesions. The skin biopsy report showed CD3/CD8 lymphocytic rimming of the adipocytes and the patient was diagnosed with subcutaneous panniculitis-like T cell lymphoma. A subsequent bone marrow biopsy showed hemophagocytic lymphohistiocytosis. The patient underwent treatment with the cyclophosphamide, hydroxydaunorubicin, Oncovin, prednisone, and etoposide chemotherapy regimen and received an autologous peripheral blood stem cell transplant. CONCLUSIONS Nodular skin lesions can result from a variety of noninfectious causes in addition to bacterial and fungal infections. This case highlights the importance of early biopsy of skin lesions that do not respond to standard therapy to establish an accurate diagnosis and start timely treatment to prevent poor outcomes.

Initial Presentation of Disseminated Coccidioidomycosis with Ocular Lesions.

Ocular involvement with disseminated coccidiodal infection is rare. Even rarer is a patient presenting with symptomatic chorioretinitis first, followed weeks later by systemic symptoms of disseminated coccidioidomycosis. This highlights the need for physicians to have a heightened suspicion for testing for valley fever in patients living in endemic regions who present with ocular inflammation so that rapid and timely initiation of antifungal therapy may prevent loss of vision.

Neuroinvasive cryptococcosis in an immunocompetent patient with a negative spinal fluid cryptococcus antigen.

58-year-old man presented with headache, nausea, vomiting, and gait disturbance. Brain MRI showed meningeal enhancement and herniation. Serum Cryptococcus antigen was positive but spinal fluid antigen and cultures were negative. A cerebellar biopsy revealed nonencapsulated Cryptococcus. He completed antifungal therapy. Serum Cryptococcus antigen titer decreased. He had a full neurological recovery.

Pseudomonas bacteremia as an initial presentation of SLE.

Infections have been commonly implicated in lupus relapses and in some cases as initiating the diagnostic work up of systemic lupus erythematosus (SLE). We describe here the case of a young patient who presented with Pseudomonas aeruginosa bacteremia and was found to have a new diagnosis of SLE. 53% of patients with active SLE and abdominal pain have intestinal vasculitis. These vasculitic changes can cause intestinal ischemia with consequent translocation of pathogens from the gastrointestinal tract to the bloodstream causing sepsis.