Acquired ichthyosis as a paraneoplastic feature of ALK‐negative anaplastic large cell lymphoma

Abstract

A 54-year-old man was referred to our department with features of whole-body ichthyosis (left), which had developed gradually in the preceding two months. During this period, he also experienced night sweats and persistent fever. On examination, an axillary mass measuring 3 cm in diameter was identified. His full blood count showed anaemia with mild thrombocytosis and mild leucocytosis. Skin biopsy showed hyperkeratosis and epidermolysis and absence of any neoplastic infiltrate. Lymph node biopsy revealed a population of large pleomorphic cells, which were CD30+ (right), partially CD4+, CD8 , PAX5 and ALK1 . A diagnosis of ALK-negative anaplastic large cell lymphoma (ALCL) with paraneoplastic ichthyosis was therefore made. The disease was staged as IIIB and the patient was commenced on chemotherapy. Acquired ichthyosis is a rare condition that should always prompt extended clinical evaluation. In some cases, it is associated with endocrine disease, medications or infection, but it is most often a paraneoplastic cutaneous process encountered in various malignancies. Interestingly, acquired ichthyosis has been previously reported in other CD30+ lymphomas, including Hodgkin lymphoma and ALK-positive ALCL. The skin condition further worsens the prognosis of this aggressive lymphoma.