A 50-year-old woman presented to the dermatologist with a swollen lip and painless ulcer on her palate. She even complained of intermittent fever and general malaise. In addition to this, she had a 3-year history of purulent discharge and general malaise, for which she was prescribed antibiotic agents and intranasal glucocorticoids.
Physical examination showed a large ulcer with a necrotic base that extended over the soft and hard palates. Fibrinoid exudate covered the surrounding erosions, in addition to discoloured nasal discharge and a swollen upper lip.
Laboratory results showed a white-cell count of 2200 per cubic millimetre (reference range, 12 to 15), a platelet count of 65,000 per cubic millilitre (reference range, 150,000 to 400,000), and a ferritin level of 18,745 ng per millilitre (reference range, 12 to 263). Histopathology of the biopsy specimen showed lymphoid proliferation with positive staining for granzyme B, CD56 and CD3. In addition to this, Epstein-Barr virus was detected on in situ hybridization.
The findings were consistent with extranodal natural killer T-cell lymphoma, nasal type.
Bone marrow biopsy was performed which showed evidence of hemophagocytosis (phagocytosis by histiocytes of platelets, leukocytes, erythrocytes and their precursors in bone marrow and other tissues), which is associated with disease.
Unfortunately, the patient passed away 1 month later, even after chemotherapy was initiated.
References
Shen, M. H., & Wu, M. Y. (2020). Palatal Ulceration. New England Journal of Medicine, 383(5), 474-474.