Disseminated mantle-cell lymphoma presenting as a petechial maculopapular eruption.

Report of a Case | A man in his early 50s presented with a petechial maculopapular eruption with rapid dissemination to the entire body including the face and ears. Peripheral lymphadenopathy was noted. He also had an elevated white blood cell count of 26 900/μL. (To convert white blood cell count to ×109/L, multiply by 0.001.) He had mild pruritus with no other constitutional symptoms. Skin biopsies showed a prominent perivascular and periadnexal infiltrate of small to mediumsized monomorphic lymphocytes with focal erythrocyte extravasation but without evidence of vasculopathy or vasculitis. Immunohistochemical analysis revealed CD20+, CD5+, cyclin-D1+, CD3-, CD10-, and CD23-, infiltrate, consistent with cutaneous involvement by MCL (Figure). Staining for skinhoming molecules revealed a cutaneous lymphocyteassociated antigen (CLA), L-selectin (CD62L)+ infiltrate. Laboratory investigations showed peripheral blood and bone marrow involvement by MCL with chromosomal translocation t(11;14), and positron emission tomographic/ computed tomographic scans revealed diffuse lymphadenopathy. The patient was started on intensive chemotherapy followed by allogeneic stem cell transplant.