Philippine E-Journals

Coexistence of Leprosy and T-Cell Lymphoma in a 49-Year-Old Female

Tifany P. Que | Sharon Margaret V. Wong | Cindy Jao Tan | Camille Berenguer-Angeles | Lian C. Jamisola

 

Abstract:

Introduction The occurrence of malignant tumors associated with leprosy has been observed, with lymphoma being the most commonly associated non-epithelial malignant tumor and may be due to the depressed immunologic surveillance. The converse where leprosy manifests in a lymphoma patient undergoing chemotherapy has also been mentioned in a few articles. Case Summary A 49-year-old female was diagnosed to have peripheral T-cell lymphoma after an initial presentation of enlarged lymph nodes, generalized asymptomatic papules and plaques on the trunk, and pancytopenia. Two weeks after initiation of chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP), her skin lesions progressed to become violaceous to slightly hyperpigmented. Further query revealed a year-long history of hypoesthesia of the lower extremities. Histopathologic examination revealed nodular histiolymphocytic infltrates surrounding blood vessels, adnexal structures, and nerves, consistent with lepromatous leprosy. Fite-Faraco stain was positive. Due to lymphoma-related pancytopenia, the patient was given monthly rifampicin, ofoxacin and minocycline (ROM) chemotherapy, alternatively. Erythema nodosum leprosum reaction developed for which clofazimine was given, resulting in improvement. Conclusion Leprosy is a great mimicker and dermatologists need to be adept at diagnosing skin conditions in immunocompromised patients, especially since disease course and manifestation may be modifed in this subset of patients. Leprosy must be considered when granulomatous lesions arise in lymphoma patients before ascribing them to the underlying disease. Management may also be challenging due to the comorbidities, which may limit treatment options. Careful history, clinical clues, histopathologic correlation, and prudent therapeutic approach are important tools in addressing these cases.