A case of pseudolymphoma of the facial skin as a reaction to professional exposure to dichloroethane

Benign cutaneous lymphoplasia — the most common clinical form of skin pseudolymphoma, non-specific clinical manifestations of which create difficulties for diagnosis, leads to erroneous diagnoses. We present a clinical case of development of benign lymphoplasia of the facial skin in a patient, 53 years old, who sought help from a dermatovenereologist with a complaint about the appearance of multiple dense itching nodules on the facial skin. Primary clinical diagnosis: acneiform dermatosis? The patient is referred for consultation to the Ural Research Institute of Dermatovenereology and Immunopathology. Past medical history: he has professional contact with a highly hazardous chemical substance — 1.2-dichloroethane, which has skin-resorptive effect, for about 4 years. Preliminary clinical diagnosis: photodermatosis? skin sarcoidosis? The performed incisional skin biopsy in the pathological process area revealed atypical lymphoid proliferation, nodular non-epidermotropic infiltrate predominantly from small lymphoid cells with admixture of histiocytes, single eosinophils. An immunohistochemical study was carried out to exclude malignant lymphoproliferative process. Conclusion: the infiltrate has a mixed predominantly T-cell composition. Histoarchitecture and immunophenotype of the infiltrate are characteristic of benign cutaneous lymphoplasia (nodular T-cell pseudolymphoma). Based on the clinical picture, data of immunohistopathological and pathomorphological studies of skin biopsy sample, the following diagnosis has been established: cutaneous T-cell pseudolymphoma, infiltrative plaque form of Jessner — Kanoff’s benign cutaneous lymphoplasia. Positive dynamics of the skin process was obtained after the therapy performance with the exclusion of contact with dichloroethane. Clinical observation confirms the need for a detailed examination of the disease history (including professional route), which allows to identify the precipitating factor for the disease development, carry out differential diagnosis based on analysis of the history data, clinical findings, pathomorphology and immunohistochemistry.