LICHENOID PARANEOPLASTIC PEMPHIGUS ASSOCIATED WITH A LOW-GRADE NODAL LYMPHOMA

Background. The precise diagnostic criteria for paraneoplastic pemphig us defined by Anhalt are not always present. In many cases, the clinic al and histological features are misleading. Case report. We observed a case of paraneoplastic pemphigus in a 60-year-old mon followed for l ow-grade inactive nodal lymphoma. The clinical course was long. The ma in features were lichenoid cutaneous and mucosal lesions without bulla e. The only histology finding was basal vacuolization, lymphocyte infi ltration and suspended keratinocyte necrosis without acantholysis. Thi s clinical and pathological situation continued for one year. Just a f ew days prior to the patient's death, the clinical situation suddenly worsened with major bullae involving most of the skin surface and muco sal areas including the esophagus and respiratory tract. Cyclosporine and bolus injections of corticosteroids did not prevent the fatal outc ome. Discussion. This unusual lichenoid presentation has not been prev iously described. Associated skin erosions usually occur early in the disease course. The long lichenoid presentation for several months wit hout acantholysis emphasizes the difficulties encountered in the diagn osis of paraneoplastic pemphigus. This diagnosis should be entertained in cancer patients who develop lichenoid lesions.