Indolent fever, weight loss and spleen infiltrate.

This is a case of a young female who was admitted to our department with fever of one month in duration, without a specific pattern, anemia, lymphadenopathy and weight loss. The initial clinical and radiological evaluation and laboratory tests, although extensive, were unrevealing. The patient's general situation was temporarily improved and she was dismissed, but she revisited our hospital 2, 5 months later because of fever recurrence and a new pain at the upper left abdomen. This time the pathological findings were more prominent. The abdomen CT scan revealed a splenic mass. The evidence was suggestive of lymphoma, granulomatous or unusual infectious disease. However, it was not possible to establish a certain diagnosis, so we proceeded to open splenectomy and histological analysis that disclosed an inflammatory pseudotumor of the spleen. This procedure apart from diagnostic proved to be also therapeutic. The patient was cured and at six-month follow up she was in perfect health. Our case suggests that a high index of suspicion regarding this entity is needed, particularly if the disease course is variable and protracted.

Follicular mucinosis associated with early stage cutaneous T-cell lymphoma: successful treatment with interferon alpha-2b and acitretin.

BACKGROUND: Follicular mucinosis (FM) is a rare dermatosis characterized by mucin deposits in the pilosebaceous units. It is divided into a primary-benign type and a secondary type associated mostly with lymphomas. No standard effective therapy is available for the primary FM while in the secondary form treatment is aimed against the underlying disease. METHODS: We report a case of secondary FM in which a cutaneous T-cell lymphoma was detected 6 years after the initial eruption. RESULTS: Complete remission was achieved with combination therapy of interferon alpha-2b at a dose of 6 million U subcutaneously three times a week, and acitretin 35 mg/day, for 6 months. CONCLUSION: Regular clinical and histopathological evaluation is suggested for all patients with FM. For cases associated with cutaneous T-cell lymphoma the combination of interferon alpha and acitretin seems to be a good therapeutical approach.

Concomitant angioimmunoblastic T-cell lymphoma and low grade B-cell lymphoproliferative disorder.

The presence of a rearranged immunoglobulin gene, in addition to the expected T-cell receptor gene rearrangement, is a frequent, albeit poorly understood, finding in the setting of angioimmunoblastic lymphadenopathy. A case of an angioimmunoblastic T-cell lymphoma is presented, where this apparently paradoxical dual gene rearrangement could be ascribed to the coexistence of an occult B-cell lymphoproliferative disorder.