Subcutaneous panniculitis-like T-cell lymphoma and lupus erythematosus profundus: a diagnostic dilemma.

A white Caucasian woman in her 30s presented with an indurated lesion on her right upper arm. Panniculitis was clinically suspected. Antinuclear antibody testing was positive but incisional biopsy showed subcutaneous panniculitis-like T-cell lymphoma (SPTCL), although with some unusual features more in keeping with lupus. Initial treatment was with oral prednisolone and radiotherapy but with only partial response. A second biopsy was taken from an area of presumed residual disease. This displayed histological features that were much more typical of lupus erythematosus profundus (LEP) but with tiny foci suggesting concomitant microscopic areas of SPTCL. Immunofluorescence for IgM was positive. This case highlights the rare occurrence of a patient with overlapping clinical and pathological features of SCPTL and LEP. It emphasises the need for close clinicopathological correlation in the workup of patients with suspected panniculitis and the importance of careful pathological examination for features of both diseases.

Paraneoplastic erythroderma: unusual presentation secondary to diffuse large B cell lymphoma.

A 34-year-old HIV-positive man presented in clinic with generalised erythroderma, having been lost to follow-up for the previous 3 years. He was CD4 lymphopenic (100×106/L) and was antiretroviral therapy naive. Initial histology from a skin punch biopsy was non-specific and he was treated with topical steroids and emollients for a suspected eczema. However, the erythroderma worsened with development of cervical lymphadenopathy and significant weight loss over a 6-week period. An incisional biopsy from the left tonsil confirmed a diagnosis of diffuse large B-cell lymphoma. The erythroderma was considered to be a paraneoplastic skin phenomenon. The patient received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone (CHOP) immunochemotherapy with gradual but complete resolution of the erythroderma. Paraneoplastic dermatoses can manifest as first clinical sign of underlying malignancy, heralding a cancer diagnosis. This is particularly important in people living with HIV given the increased incidence of malignancy in this patient group.

Pelvic fragility fractures in older people admitted to hospital: the clinical burden.

INTRODUCTION: Pelvic fragility fractures are common in older people. To deliver better care in hospital, a better understanding of their characteristics and outcomes post-hospitalisation will allow clinicians to better design hospital services to manage their needs. METHODS: Using routinely collected electronic hospital records over 3 months, data were collected and analysed on consecutive patients admitted with pelvic fragility fractures (as defined by a pelvic fracture sustaining following a fall from standing height or less) to acute medical wards for older people. RESULTS: Twenty-four patients were admitted over this period. Their mean age was 87 years (SD 9.4), the majority were female (83%), a significant proportion had cognitive impairment with an abbreviated mental test score of ≤ 7 (67%), and the median number of comorbid conditions was three. These patients were at high risk of future fractures (50% with a known diagnosis of osteoporosis; significant FRAX scores; 75% had a fall) but only 50% had a bone health assessment. The median duration in hospital was 13 days. 33% of patients were discharged home directly while the rest were discharged to either a care home or another hospital for further rehabilitation. 54% had a hospital-related complication including kidney injury, delirium, and hospital-acquired infections-there were two inpatient mortalities. At 3 months post-fracture, 54% were readmitted and 33% died. CONCLUSION: Pelvic fragility fractures are associated with worse inpatient and post-discharge clinical outcomes. This is an older multi-morbid cohort needing significant post-fracture rehabilitation care. Their care in hospital needs to address their management complexities.