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A 58-year-old man presen ts with generalized erythroderma with associated pruritis. weigh t loss . and cold intolerance. In addition to the generalized skin changes. he has generalized lymphadenopathy and hyperkeratosis of the palms and soles on physical exam. Com plete blood count shows leukocyte count of 22. 300/,LLL. hemoglobin 1 2 .6 g/dl. and platelet count 1 6LJ .OOO/pl. Peripheral blood smear is shown below.
What is the most likely diagnosis?
- Sezary syndrome (SS)
- Acute myeloid leukemia (AML)
- Hairy cell leukemia (HCL)
- Chronic lymphocytic leukemia (HCL)
Medicine
A. The peripheral blood shows lymphocytes with condensed chromatin and "cerebriform" nuclei and vacuoles in the cytoplasm. This finding plus the patient's history and physical exam is char-acteristic of SS. Immunophenotype showed expression of CD2, CD3, and CD4 and lack of CD7. T-cell receptor (TCR) gene rearrangement was noted.
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