Extranodal natural killer/T-cell lymphoma, nasal type, with prominent granulomatous reaction

摘要

A 70-year-old Japanese male noticed erythematous eruptions on his lower extremities approximately 2 months before his initial visit to our hospital. He had no prior history of autoimmune disease, malignancy including lymphoproliferative disorders or immunosuppressive treatment. The eruptions rapidly increased and became necrotic. He then noticed nasal congestion with purulent discharge. He was diagnosed with vasculitis by skin biopsy and was referred to our hospital in April 2012. He presented with many cutaneous indurated erythematous plaques predominantly on the lower extremities. Multiple skin ulcers and necrotic lesions were also observed (Fig. 1a). Lactate dehydrogenase (251 U/L), C-reactive protein (6.50 mg/dL) and soluble interleukin-2 receptor (1610 U/L) were elevated. Antinu-clear antibodies, antineutrophil cytoplasmic antibodies and anti-human T-lymphotropic virus type-1 antibodies were not detected. Computed tomography imaging of the whole body showed abnormal soft tissue shadow distributed from the left middle meatus to maxillary sinus without visceral involvement.