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- W2340149375 abstract "A 45-year-old man with a history of diabetes and hypertension presented to the emergency department (ED), complaining of ruptured blisters on his right forearm and posterior part of the neck. They began more than a year ago on his right forearm and spread to include his neck just 3 weeks before his visit. He was treated at another ED 7 weeks before and received an oral antibiotic after a clinical diagnosis of “infection.” He noted no improvement. On physical examination, he had large ulcerated areas at the right forearm (Figure 1), some confluent, with raised erythematous and indurated margins. A solitary ulceration at the posterior part of the neck was also present (Figure 2). A skin biopsy was obtained.Figure 2Posterior right side of the neck.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Cutaneous anaplastic large-cell lymphoma, T-cell CD30 antigen positive, ALK antigen negative. Cutaneous lymphomas are divided into T-cell and B-cell origins. T-cell lymphomas are more common and further divided into mycosis fungoides (CD4 cell origin), cutaneous anaplastic large-cell lymphoma with positive CD30 antigen markers, or rare γ-Δ T-cell lymphoma.1Wolff K. Johnson R.A. Saavedra A.P. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology.7th ed. McGraw Hill, New York, NY2013: 463-475Google Scholar, 2Alexander R.E. Webb A.R. Abuel-Haija M. et al.Rapid progression of primary cutaneous gamma-delta T-cell lymphoma with an initial indolent clinical presentation.Am J Dermatopathol. 2014; 36: 839-842Crossref PubMed Scopus (10) Google Scholar, 3Klemke C.D. Cutaneous lymphomas.J Deutschen Dermatologischen Gesellschaft. 2014; 12: 7-28PubMed Google Scholar Biopsy is required to accurately diagnose cutaneous lymphoma. Cutaneous lymphomas and their presenting manifestations can be challenging.4Arps D.P. Chen S. Fullen D.R. et al.Selected inflammatory imitators of mycosis fungoides: histologic features and utility of ancillary studies.Arch Pathol Lab Med. 2014; 138: 1319-1327Crossref PubMed Scopus (23) Google Scholar Physical findings initially present as erythematous plaques and nodules that progress to enlarging masses with central ulcerations.3Klemke C.D. Cutaneous lymphomas.J Deutschen Dermatologischen Gesellschaft. 2014; 12: 7-28PubMed Google Scholar, 5Eberle F.C. Metzler G. Weisel K.C. et al.Cutaneous presentation of hematological malignancies.Eur J Dermatol. 2013; 23: 372-377PubMed Google Scholar The lesions may be asymptomatic, pruritic, or painful.6Barman T.K. Shahidullah M. Rahman M.H. et al.Sixty years old man with primary cutaneous lymphoma.Mymensingh Med J. 2015; 24: 182-185PubMed Google Scholar Cutaneous lymphoma can also be mistaken for an inflammatory process, and ultrasonography may mimic an abscess with hypoechoic expansile formation in the subcutaneous tissue.7Barbosa L. Brito M.J. Balaco I. et al.Anaplastic cutaneous lymphoma mimicking an infection.J Radiol Case Rep. 2014; 8: 39-47PubMed Google Scholar The patient improved after 4 months with chemotherapy." @default.
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- W2340149375 date "2016-05-01" @default.
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- W2340149375 title "Ulcerations on the Neck and Forearm" @default.
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- W2340149375 doi "https://doi.org/10.1016/j.annemergmed.2015.09.002" @default.
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