Persistent Agminated CD30+ Lymphoproliferative Disorder: Cas
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Lymphomatoid papulosis (LyP) is a chronic skin condition, characterized by recurrent eruptions of papules and nodules with or without central necrosis that spontaneously resolve.

A 38-year-old female presented with concern about an eruption on her right leg for at least two years in duration prior to treatment. She had no significant past medical, surgical or family history, and was taking no medications or over-the-counter supplements. On physical exam, she had a cluster of 5–10 mm pink to red papules in an agminated pattern on her right antero-medial thigh.

A punch biopsy was performed and sent for histopathological analysis. Pathology showed a dense, wedge-shaped lymphoid infiltrate with abundant CD3+/CD30+ enlarged atypical T-lymphocytes with significant exocytosis. There was associated papillary dermal edema with admixed reactive lymphocytes and eosinophils. CD20 immunostaining did not highlight a significant B-cell population. Direct immunofluorescence showed no IgG, IgA, IgM, C3, C5b-9, or fibrinogen deposition. Combining the clinical and histopathological findings, LyP was favored due to the significant positive CD30 staining, although clinically her course was atypical.

The patient was started on clobetasol propionate 0.05% ointment BD for four weeks leading to almost total resolution of her lesions. However, four months after the point when the lesions had nearly resolved, after she had stopped the treatment, they reappeared in exactly the same location.

This report describes a unique case of an atypical lymphoproliferative eruption that did not regress until high potency topical steroids were applied. In light of the overall clinicopathologic presentation, the patient’s clinical course most closely aligns with a persistent agminated CD30+ lymphoproliferative disorder, which has been reported mainly in case reports before, though not fully classified by the WHO at this current time. In patients such as this one, it is important to monitor them over time as the clinical presentation may evolve.

Source: https://jddonline.com/articles/dermatology/S1545961620P1005X/3
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