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Cutaneous adult T-cell leukemia/lymphoma presenting as sweet syndrome

Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive peripheral T-cell lymphoid neoplasm associated with the human T-cell lymphotropic virus type-1 (HTLV-1) infection. Cutaneous manifestations of ATLL are diverse with clinical and histopathologic features mimicking various skin conditions [1]. As a result, one-third of patients with cutaneous manifestations of ATLL are initially misdiagnosed, which has led to its classification as an emerging public health problem in northeastern urban communities with large Caribbean migrant populations such as ours [2]. The most common clinical manifestations of ATLL include nodulotumoral-type lesions, plaques, and patches and clinicians are most habituated to identifying such lesions [3]. However, familiarization with the published literature identifies multiple case reports of atypical cutaneous manifestations of ATLL that inevitably perplexed providers on initial presentation [4–6]. Often, these patients were empirically treated for the disease being clinically mimicked and ultimately required histopathologic analysis for accurate diagnosis after initial attempts at treatment were unsuccessful. We present a case of ATLL with atypical cutaneous manifestations that due to appropriate, early dermatologic diagnosis reconnected the patient with his oncology team to begin salvage chemotherapy and address the inevitable, morbid clinical deterioration that soon precipitated due to advancement of this aggressive disease.