Cutaneous vasculitis and T-large granular lymphocyte leukaemia with parallel evolution

Abstract

Conflicts of interest: none declared. Sir, We describe an 86‐year‐old woman who presented in February 2002 with a 3‐week history of purpura. The lesions were symmetrically distributed and showed as a petechial purpura and ulceronecrotizing papules of the limbs (Figs 1 and 2). Clinical examination was otherwise normal. Histological examination of two skin biopsy specimens obtained from a necrotic lesion showed a deep leucocytoclastic vasculitis with a mixed perivascular inflammatory infiltrate and capillary necrosis. There was no immunoglobulin deposit (especially IgA). The lymphocyte count was 6·6 × 109 L−1 (normal 1·0–4·0 × 109), with 55% (3·6 × 109 L−1) monoclonal large granular lymphocytes (LGLs) [CD3+, CD4+, CD8+, CD56+, T‐cell receptor (TCR) αβ, Vβ 13.1]. Blood testing was negative for viral hepatitis, human immunodeficiency virus, cytomegalovirus, Epstein–Barr virus, antinuclear antibodies, rheumatoid factor and antineutrophil cytoplasmic antibodies. Serum protein electrophoresis, and renal and liver function tests were normal. A whole‐body computed tomographic scan revealed no abnormalities. The diagnoses of cutaneous vasculitis and T‐LGL leukaemia were made.