Cutaneous T Lymphoma: A Challenging Differential Diagnosis"

Abstract

Cellulitis, a common infection of the skin and subcutaneous tissue, relies on a clinical/microbiological diagnosis. This is a case of an 80-year-old woman, with personal history of nasal basal cell carcinoma and recurrent dacryocystitis, examined for fever and 6-month evolution facial skin lesions with canker sores, maintained despite antibiotic and antiviral therapy. Due to the diagnosis of facial cellulitis and lack of response to the empiric antibiotic therapy, a broad-spectrum antibiotic was chosen, with vancomycin and ceftriaxone, also proven ineffective. After isolation of Enterococcus faecalis, adjustments were performed according to the sensitivity test. The investigation was widened with an autoimmune study and thoracoabdominal-pelvic computed tomography, both without changes. The biopsy histologic study allowed the diagnosis of cutaneous T lymphoproliferative disease. Prednisolone was initiated with resolution of the lesions. In the absence of response to targeted therapy, cellulitis represents a diagnostic challenge, motivating a broad investigation, in which the histological study is essential.