CD30+ Anaplastic large cell lymphoma with bullous lesions: Good results with steroid + cyclosporine treatment

Anaplastic large cell lymphomas (ALCLs) are type of lymphomas with a strong CD30 positivity. A 38 year old lady presented with tender nodules over forearms and thighs, blisters and ulcerations over forearms, swelling of parotids and induration over forearms, flanks and left breast. MRI showed subcutaneous oedema of anterior abdominal wall, oedema of left breast extending into the parenchyma, hepatosplenomegaly. Histopathology revealed rimming of fat cells by atypical lymphoid cells, immunohistochemistry studies revealed CD30, CD3, CD4, CD5 positivity. T cell receptor gamma chain gene rearrangement (TCR) assay showed an oligoclonal population of T cells. The patient was started on parenteral steroids and oral cyclosporine. The bullae and ulcers healed, the induration score dropped from 15 to 0 in 21 days. The drugs were gradually tapered to a maintenance dose. There was complete remission with cyclosporine and steroids with no evidence of relapse after 16 months. Hence cyclosporine and steroids can be used either singly or in combination depending on the severity, dissemination and response.