Anaplastic Large Cell Lymphoma Masquerading as an Infectious Syndrome

Abstract

The clinical manifestations of anaplastic large cell lymphoma can be remarkably deceptive. A 41‐year‐old female presented with fever, productive cough, fatigue, arthralgias, and lymphadenopathy. She had been camping in the Southwest, and had visited some bat caves. At the same time, her son developed a similar illness. The patient’s white cell count was 23,000, and radiology demonstrated diffuse bilateral infiltrates. Extensive workup for bacterial and fungal organisms were noncontributory, however, a viral exposure could not be excluded. The patient subsequently developed an umbilicated vesicular rash on her torso. Initial skin biopsies showed a perivascular mixed infiltrate, with no evidence of microorganisms. After clinical progression, a subsequent skin biopsy demonstrated a perivascular infiltrate of large mononuclear cells, with vesicular nuclei and abundant cytoplasm, immunophenotypically characteristic of anaplastic large cell lymphoma. With elucidation of the process, lymphomatous involvement of the blood, pleural fluid, CSF, and nodal tissue was identified. Despite chemotherapy, the patient passed away. Exposure to an infectious agent may have unmasked the patient’s lymphoma.