[Chronic prurigo revealing an angio-immunoblastic T cell lymphoma]

Cutaneous manifestations in angio-immunoblastic T cell lymphoma [AITL] can be seen in almost 50% of patients. They are especially represented by maculo-papular pseudotoxic exanthema. The other manifestations, like nodular prurigo are rarely observed. We report a case of AITL diagnosed after an etiologic screening for chronic prurigo. The objective of our work is to stress on the possibility to diagnose a hemopathy in etiologic screening of chronic pruritus. A 45-year-old patient presented a chronic pruritus of 18 months associated with general manifestations [fever, night sweating and weight loss]. Physical examination showed diffuse adenomegalies. On histology, the lymph nodes were composed of polymorphous lymphoid proliferation made of middle to large sized cells with clusters of epithelioid cells and post-capillary veinules hyperplacia. Immunohistochemical study showed T cell phenotype [CD3+]. Large cells were CD30+. Latent Protein of EBV virus was not expressed. Molecular biological analysis of a lymph node showed a T cell clonal proliferation. Cutaneous biopsy showed a little dermic perivascular lymphocytic inflammatory infiltrate. The diagnosis of angio-immunoblastic T cell lymphoma was made. The abdomino-pelvian CT scanner showed multiple inter-aortico-cave lymph nodes and a splenomegaly. A polychemotherapy was initiated. In front of chronic prurigo with general manifestations, a careful etiologic screening should be done to detect internal disorders especially malignant hemopathies