Race for the Case answers

Diagnose this new case by Bryan Daines, DO

A 60-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and gastroesophageal reflux disease presented to the emergency department due to multiple painful skin lesions that arose after the patient went camping locally two weeks prior. The patient reported subjective fevers and chills prior to hospital admission. The patient also reported blood in his stool for the past few months. The patient was started on broad spectrum antibiotics by primary care prior to dermatology consultation.

1. Initial biopsy results favored histiocytoid Sweet’s syndrome. What is the initial treatment for histiocytoid Sweet’s syndrome?

Answer: Prednisone 0.5-1.0 mg/kg daily tapered over 4-6 weeks

2. Lesions resolved after treatment, but subsequently recurred. Repeat biopsy showed CD-30+ lymphocyte aggregates. What is the most likely diagnosis?

Answer: Lymphomatoid papulosis

3. Which other lymphoproliferative disorder should also be considered that is CD-30+?

Answer: Anaplastic large cell lymphoma

4. If symptomatic, what is the best treatment for the patient's condition?

Answer: Methotrexate or phototherapy

5. 25% of patients with this condition have an antecedent, concurrent, or subsequent malignant lymphoma. Which lymphoma is most common for these patients to have?

Answer: Mycosis fungoides (followed by anaplastic large cell lymphoma and Hodgkin lymphoma)