Diffuse large B-cell lymphoma-leg type masquerading as venous eczema

Primary cutaneous diffuse large B-cell lymphoma-leg type (PCDLBCL-LT), is a rare high-grade form of primary cutaneous lymphoma. It often presents as red to violaceous nodules or plaques on lower limbs. We report a case of PCDLBCL-LT presenting initially as cellulitis. The skin changes did not respond to oral and intravenous antibiotics and management for venous eczema was subsequently commenced. The patient then developed 2 large deep subcutaneous masses and core biopsy confirmed a diagnosis of a mature high-grade B-cell lymphoma. Review of the patient’s history revealed a prior diagnosis of high-grade B-cell lymphoma 22 years previously. This case demonstrates that PCDLBCL-LT can present with clinical signs in keeping with a diagnosis of cellulitis or venous eczema. In the context of progressive nodular skin changes biopsy should always be considered, particularly when the patient has a prior history of a hematologic malignancy.