Unusual periungual nodulocystic lesions leading to the diagnosis of extranodal marginal zone lymphoma
Abstract
We report a 91-year-old female who was examined for a 6 month lasting periungual nodulocystic lesions with dystrophic nails affecting several digits of the upper extremities [Figure 1]a. Lesions were painful.
Patient was on oral antidiabetics and antihypertensive medication, otherwise she was healthy. She had been treated by another dermatologist with systemic itraconazole with the suspicion of candidal paronychia with no effect.
General blood count was normal. Biochemistry examination revealed slightly elevated uric acid.
We consulted a rheumatologist who excluded gout and periungual lesions as tophi. General physical examinations including chest X-ray and abdomen ultrasound were normal.
We performed a punch biopsy with the result of extranodal marginal zone B-cell lymphoma [Figure 2]a and [Figure 2]b. The patient had no systemic symptoms of lymphoma.
She was immediately examined by a hematologist. Lymphoma cells were found in microscopy of peripheral count examination by the hematologist and we concluded that the skin lesions were secondary cutaneous manifestations of systemic B-lymphoma.
Because of the age of patient, no further tests were performed to examine if any other organs were affected (gastric mucosa, colon, etc). The serology for Helicobacterpylori and Borrelia burgdorferi were negative.
The patient declined a bone-marrow examination. The systemic therapy with repeated cycles of dexamethasone and chlorambucil was initiated with excellent effect to the skin lesions.
After 2 months, almost complete regression was observed