Recurrent angio-oedema and solitary molluscum contagiosum as presenting signs of non--Hodgkin's B-cell lymphoma
Authors: J. Arnold, N. Berens, E-B. BrOcker, M. Goebeler
Journal: British Journal of Dermatology (2002)

Correspondence: Matthias Groebeler E‐mail: goebeler‐m.derma@ mail.uni‐wuerzburg.de Sir, Some dermatoses that are usually benign and sporadic may occasionally occur as a consequence of internal malignancies.1, 2 As these may precede signs of the malignancy, correct interpretation of skin signs can provide an opportunity for early recognition of neoplasia and rapid initiation of adequate therapy. We report the coincident occurrence of recurrent angio‐oedema and molluscum contagiosum which led to the diagnosis of non‐Hodgkin's B‐cell lymphoma. A 73‐year‐old woman presented with recurrent swelling of the face, especially the lips, which lasted for up to 4 days. In the months prior to admission, four attacks of angio‐oedema had occurred that were not affected by systemic corticosteroids or antihistamines. There was no history of hereditary angio‐oedema (HAO) and she was taking no medication potentially associated with angio‐oedema. Examination showed swelling of the lower lip, but no urticaria. Additionally, a solitary skin‐coloured papule of 5‐mm diameter with central umbilication was noticed in the left nasolabial crease. General examination was unremarkable; in particular, there were no clinical signs of lupus erythematosus and no lymphadenopathy. Routine laboratory values including haemoglobin (14·9 g dL−1) and white blood cell count (7·7 × 109 L−1 with 5·12 × 109 L−1 neutrophils and 2·25 × 109 L−1 lymphocytes) were normal, and atypical peripheral lymphocytes were not detected. C1‐esterase inhibitor (C1INH) concentration was reduced (6 mg dL−1; normal > 21) and its functional activity was diminished (41%; normal > 70%). C4 concentration was slightly reduced, but C3 levels were normal. Antibodies against C1INH were not detectable. Total concentrations of immunoglobulins were normal, and monoclonal gammopathy, cryoglobulins and cold agglutinins were not detected. Serology for human immunodeficiency virus (HIV) was negative but she had positive test results for borreliosis [IgG positive in enzyme‐linked immunosorbent assay (ELISA), immunofluorescence and western blot; IgM positive in ELISA], syphilis (treponemal haemagglutinin assay titre 1 : 640; Venereal Disease Research Laboratory test titre 1 : 64; fluorescent treponemal antibody absorption test, ELISA and western blot IgG and IgM negative), rheumatoid factor (30·6 IE; normal < 5·0) and elevated C‐reactive protein (12·7 mg L−1; normal < 10·1). Antinuclear antibody titre, earlier found by the patient's general practitioner to be elevated, was negative on admission. The nasolabial papule was excised and histology confirmed the clinical diagnosis of molluscum contagiosum. Chest X‐ray, ultrasound of abdomen, and axillary, cervical and inguinal lymph nodes, and computed tomographic scans of neck, chest and abdomen, showed no evidence of lymphadenopathy or hepatosplenomegaly. Bone marrow biopsy revealed infiltration with a lymphoplasmocytic lymphoma, an indolent non‐Hodgkin's B‐cell lymphoma.