B-cell lymphoma mimicking rhinophyma

Abstract

Conflict of interest: none declared. A 78‐year‐old woman was referred with a history of a persistent rash in the groins that had failed to improve with mid‐potency topical steroid. Examination revealed a poikilodermatous eruption that was suspicious for cutaneous T‐cell lymphoma. Incisional biopsy on two occasions showed a mixed infiltrate in the upper dermis that was found, using immunohistochemistry, to consist mainly of T‐helper cells (CD2+, CD3+, CD4+, CD5+, CD7+) with very few CD8+ cells. There was no epidermotropism or any Pautrier microabcesses. The lymphocytes displayed a mild degree of cytological atypia, but no convincing evidence of lymphoma was seen. T‐cell receptor gene‐rearrangement studies were negative. There were no palpable lymph nodes. A trial of narrowband ultraviolet B was unsuccessful because the patient felt claustrophobic in the cabin, and she was managed symptomatically with 1% menthol in aqueous cream and hydroxyzine 10 mg at night. The patient was kept under regular review and represented in 2005 with a 4‐month history of a bulbous swelling at the tip of her nose, clinically resembling rhinophyma (Fig. 1). Although she had a history of easy flushing, she had not noted any pustules. Short courses of oral erythromycin and aciclovir had afforded no improvement. On examination, she had nontender erythematous nodules and plaques at the tip of her nose, which had a tense and shiny appearance. She also had bilateral palpable cervical lymph nodes. The rash in the groins was unchanged.