Residency Program - Case of the Month
October 2017 - Presented by Dr. Nima Amini (Mentored by Dr. John Paul Graff)
The patient is a 76-year-old male with a history of diabetes mellitus and bullous pemphigoid. He presented with diffused erythema, edema and slight fissuring in both palms without active blisters. CBC analysis revealed a marked lymphocytosis with predominantly mature lymphocytes (WBC: 37.8 K/MM3 , Lymphocytes: 31.8 K/MM3).
Flow cytometry of the peripheral blood was performed and showed markedly elevated CD4:8 ratio (32:1). This CD4+ population was negative for CD25-, CD26-, CD30-, and showed aberrant T-cell antigen drop out (subset CD7-). There was no evidence of monotypic B-cell population and no blasts.
Sections of the punch biopsy taken from the right palm are shown below.
Click on image to enlarge.
What is most likely the diagnosis?
Choose one answer and submit.
E. A., C. or D. can be correct.
> Learn more about this diagnosis.