After cutaneous and neurological manifestations, bone and joint involvement are the most common manifestations in Hansen’s disease (HD). Sometimes, these are undiagnosed and rarely reported.

A 68-year-old Filipino, male, presented with an 8-month history of digital joint swelling on both hands. He was initially managed by Rheumatology for arthritis, partially responsive to Methotrexate and Prednisone. Immunology and lupus panel tests were unremarkable. Skin biopsy done on a solitary erythematous plaque on the back revealed granulomatous dermatitis, tuberculoid type. Fite-Faraco, AFB, PAS stains were negative. Four weeks later, he developed multiple erythematous papules and plaques on the face, ears, lower back, gluteal area, and lower extremities. Arthritis was persistent but hypoesthesia, hypohidrosis or alopecia were not reported. A repeat skin biopsy showed epithelioid to macrophagic cell granulomatous reaction compatible to HD. AFB stain and slit skin smear were positive. He was managed as a case of Borderline (BB) to Borderline Lepromatous (BL) leprosy and was started on multibacillary drug treatment (MDT) of Rifampicin, Clofazimine and Dapsone. One month later, the patient reported resolution of skin lesions and arthritis.

Approximately 75% of individuals with HD experience arthritis, which can be one of the early signs of disease. A high index of suspicion is required as it closely mimics other rheumatologic conditions.

Human ; Male ; Aged: 65-79 Yrs Old ; Arthritis ; Rheumatology

INTRODUCTION: Primary cutaneous aggressive epidermotropic CD8+ T-cell lymphoma (PCAECTCL) is a rare subtype of cutaneous T-cell lymphoma characterized by widely distributed ulcerated lesions, epidermotropic infiltrates of CD8+ cytotoxic T cells, aggressive course, high tendency to spread to extranodal sites, poor response to conventional therapies and unfavorable prognosis.

CASE REPORT: We report a 76-year-old Filipino male presenting with eight-month history of erythematous scaly patches evolving into widespread ulcerated nodules, unresponsive to topical and systemic steroids. Histopathology revealed prominent epidermotropism and lichenoid infiltrate of atypical lymphocytes. Immunohistochemistry showed positivity for CD3, CD8, Ki67 (5-15%), CD7, CD2; indeterminate for TIA-1, with high background staining; and was negative for CD20, CD30, CD4, CD5, CD56, granzyme-B, TdT, Epstein-Barr encoding region in situ hybridization (EBER-ISH), consistent with PCAECTCL. No overt metastasis was detected. The patient underwent interferon alfa 2B therapy followed by three full cycles of CHOP chemotherapy. Improvement was seen as thinning of plaques and nodules and re-epithelialization of ulcers however, severe anemia and leukopenia ensued with therapy. He then succumbed to septic shock secondary to pneumonia during the height of the COVID-19 pandemic.

CONCLUSION: This case emphasizes that despite accurate diagnosis, polychemotherapy, and favorable response to therapy, complications may still arise contributing to the poor prognosis and low fi ve-year survival rate of this condition.

KEYWORDS: T-cell lymphoma, CD8 positive, neoplasms

Lymphoma, T-Cell ; Neoplasms