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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Follicular Lymphoma Presenting as Refractory Panniculitis-like Lesions: A Case Report of Successful Salvage with Autologous Stem Cell Transplantation

  • Kristina Alaiyoud1,2
  • Nikolett Farmasi3
  • Zsófia Miltényi1,2
  • Judit Bedekovics4
  • Árpád Illés1,2
  • Ádám Jóna1,2
4 affiliations
  1. 1Department of Hematology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary
  2. 2Doctoral School of Clinical Medicine, University of Debrecen, member of ERN-EuroBloodNet (European Reference Network on Rare Haematological Diseases), 4032 Debrecen, Hungary
  3. 3Division of Clinical Immunology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
  4. 4Department of Pathology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Abstract

Background: Follicular lymphoma can be difficult to diagnose when extranodal manifestations, particularly cutaneous lesions, mimic inflammatory disease. Case Presentation: We report the case of a 52-year-old man with type 2 diabetes mellitus who presented with marked unintentional weight loss, iron deficiency anemia, elevated inflammatory markers, an approximately 100 mm bundle-like infiltration of the mesenteric adipose tissue, and panniculitis-like scalp lesions. Initial gastroenterological evaluation did not reveal malignancy. Biopsy of a cutaneous lesion showed a lobular lymphocytic infiltrate without evidence of malignancy, and IgG4-related mesenteric panniculitis was suspected. Despite treatment with colchicine, corticosteroids, and sequential immunosuppressive therapy, the cutaneous and subcutaneous lesions progressed. Re-evaluation revealed cervical lymphadenopathy, and histopathological examination of an excised lymph node established the diagnosis of grade 3A FL. Staging 18F-FDG PET/CT showed cervical and supraclavicular nodal disease, involvement of the nasal cavity and nasopharynx, and hypermetabolic cutaneous lesions. Six cycles of R-CHOP produced a partial metabolic response, with residual FDG-avid extranodal disease. Repeat biopsy confirmed persistent FL without evidence of large B-cell transformation. The patient subsequently received platinum- and cytarabine-based salvage chemotherapy and radiotherapy to the residual disease sites, followed by autologous stem cell transplantation after R-BEAM conditioning. On day +100 after transplantation, PET/CT showed complete metabolic remission, and the cutaneous lesions had healed. Conclusions: This case demonstrates that systemic FL may mimic mesenteric panniculitis and inflammatory skin disease. Persistent panniculitis-like lesions that do not respond to immunosuppressive treatment should prompt diagnostic reassessment, repeat biopsy, and careful clinicopathological correlation.

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Cite

BibTeXRIS
BibTeX
@article{alaiyoud2026follicular,
  title = {{Follicular Lymphoma Presenting as Refractory Panniculitis-like Lesions: A Case Report of Successful Salvage with Autologous Stem Cell Transplantation}},
  author = {Kristina Alaiyoud and Nikolett Farmasi and Zsófia Miltényi and Judit Bedekovics and Árpád Illés and Ádám Jóna},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218369},
  url = {https://www.mdpi.com/2077-0383/15/21/8369},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Follicular Lymphoma Presenting as Refractory Panniculitis-like Lesions: A Case Report of Successful Salvage with Autologous Stem Cell Transplantation
AU  - Kristina Alaiyoud
AU  - Nikolett Farmasi
AU  - Zsófia Miltényi
AU  - Judit Bedekovics
AU  - Árpád Illés
AU  - Ádám Jóna
PY  - 2026
DA  - 2026/10/27
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218369
UR  - https://www.mdpi.com/2077-0383/15/21/8369
AB  - Background: Follicular lymphoma can be difficult to diagnose when extranodal manifestations, particularly cutaneous lesions, mimic inflammatory disease. Case Presentation: We report the case of a 52-year-old man with type 2 diabetes mellitus who presented with marked unintentional weight loss, iron deficiency anemia, elevated inflammatory markers, an approximately 100 mm bundle-like infiltration of the mesenteric adipose tissue, and panniculitis-like scalp lesions. Initial gastroenterological evaluation did not reveal malignancy. Biopsy of a cutaneous lesion showed a lobular lymphocytic infiltrate without evidence of malignancy, and IgG4-related mesenteric panniculitis was suspected. Despite treatment with colchicine, corticosteroids, and sequential immunosuppressive therapy, the cutaneous and subcutaneous lesions progressed. Re-evaluation revealed cervical lymphadenopathy, and histopathological examination of an excised lymph node established the diagnosis of grade 3A FL. Staging 18F-FDG PET/CT showed cervical and supraclavicular nodal disease, involvement of the nasal cavity and nasopharynx, and hypermetabolic cutaneous lesions. Six cycles of R-CHOP produced a partial metabolic response, with residual FDG-avid extranodal disease. Repeat biopsy confirmed persistent FL without evidence of large B-cell transformation. The patient subsequently received platinum- and cytarabine-based salvage chemotherapy and radiotherapy to the residual disease sites, followed by autologous stem cell transplantation after R-BEAM conditioning. On day +100 after transplantation, PET/CT showed complete metabolic remission, and the cutaneous lesions had healed. Conclusions: This case demonstrates that systemic FL may mimic mesenteric panniculitis and inflammatory skin disease. Persistent panniculitis-like lesions that do not respond to immunosuppressive treatment should prompt diagnostic reassessment, repeat biopsy, and careful clinicopathological correlation.
SN  - 2077-0383
ER  -