The occurrence of secondary cutaneous manifestations in peripheral T-cell lymphoma (PTCL) is relatively infrequent and can resemble benign dermatoses, leading to diagnosis delays. We present the case of a 78-year-old female patient with a diagnosis of PTCL affecting the left parotid gland, who experienced a 2-day sudden and intensely pruritic skin eruption, which progressed from both forearms to the trunk, involving more than 50% of the total body surface area. Initially, the eruption was managed as a hypersensitivity reaction with antihistamines and corticosteroids, with temporary symptomatic relief; however, the rapid clinical progression in the context of an established diagnosis of PTCL raised suspicion of secondary cutaneous involvement. Previous pathological examinations indicated a mature T-cell phenotype (CD2 + /CD3 + /CD5 + /TCRβF1 + ), partial expression of CD4, loss of CD7 in larger cells, minimal CD30 expression (10%), and a high proliferative index (Ki-67 70%). Imaging studies demonstrated persistent disease in the parotid gland and partially necrotic cervical lymph nodes, without evidence of distant metastasis. Considering significant cardiac comorbidities and CD30 expression, an anthracycline-sparing, CD30-targeted therapeutic approach was chosen. Treatment with brentuximab vedotin yielded early alleviation of pruritus and progressive resolution of lesions by the third cycle, with favorable tolerability. This case serves as a foundation for a narrative review that underscores the diagnostic challenges associated with “allergic-appearing” eruptions in patients with T-cell lymphoma, the importance of integrated staging utilizing TNMB (skin/blood) in conjunction with Lugano/Deauville positron emission tomography–computed tomography to assess systemic burden and therapeutic response, and biologically informed systemic therapy options aligned with comorbidities, including emerging targeted treatment strategies.
Calderon et al. (Tue,) studied this question.