Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Three Challenging Leg Cases: Eosinophilic Annular Erythema, Polyarteritis Nodosa, and CD30-Positive Cutaneous Lymphoproliferative Disease
Description
This presentation reviewed three challenging leg cases. The first was an elderly woman with chronic, expanding annular and polycyclic erythematous plaques on both lower legs that left marked hyperpigmentation; biopsy showed a dense dermal eosinophilic infiltrate without vasculitis, supporting eosinophilic annular erythema, a rare figurate eruption that can resemble stasis dermatitis, and she was managed mainly with topical therapy. The second case was a woman with Crohn’s disease who developed painful subcutaneous nodules, purpuric ulceration, and peripheral neuropathy; deep biopsies revealed medium-vessel necrotizing vasculitis with thrombus and nerve involvement, confirming polyarteritis nodosa. She improved with prednisone and methotrexate, with healing of the ulcer and better neuropathy. The third case involved a man with a progressive ulcerated thigh lesion initially thought possibly infectious or malignant; biopsy showed an atypical CD30-positive lymphoid infiltrate with vascular involvement, raising a differential of lymphomatoid papulosis versus primary cutaneous anaplastic large cell lymphoma. After staging and re-biopsy, he was treated with brentuximab vedotin and had marked clinical and PET improvement.
View moreConclusions
- Eosinophilic annular erythema should be considered in persistent annular, pruritic plaques with advancing borders, dense dermal eosinophils, and residual hyperpigmentation, especially when the pattern is recurrent or bilateral.
- Cutaneous polyarteritis nodosa can present with nodules, livedoid or ulcerative leg lesions, and adjacent peripheral neuropathy, and it is often associated with inflammatory bowel disease.
- Biopsy for suspected vasculitis must be deep, multiple, and sometimes repeated, because medium-vessel disease is often missed by superficial sampling.
- In the appropriate clinical setting, a negative initial biopsy does not exclude vasculitis and should prompt re-biopsy when suspicion remains high.
- A chronic ulcer with atypical lymphoid infiltrates and CD30 positivity can represent lymphomatoid papulosis or primary cutaneous anaplastic large cell lymphoma, which may be difficult to distinguish histologically.
- Clinical course and staging studies are essential for separating LyP from ALCL, since histology alone may not be definitive and both can show angioinvasive features.
- Brentuximab vedotin can produce marked improvement in CD30-positive cutaneous lymphoproliferative disease, including lesion shrinkage and improved PET avidity.
- Across these cases, careful clinicopathologic correlation was the key to diagnosis and management of unusual leg lesions.
- Eosinophilic annular erythema (references slide citation(s) on slide 18:34)#10.5070/d33zs95220
- Polyarteritis nodosa review (references slide citation(s) on slide 18:34)
- WHO Classification of Tumors (references slide citation(s) on slide 18:34)