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Delayed Recognition of Primary Cutaneous Anaplastic Large Cell Lymphoma Mimicking Pyogenic Infection: A Lesson from Primary Care.

Early-stage cutaneous lymphoma often mimics non-malignant skin disorders, leading to common misdiagnoses and delays in appropriate treatment. A 44-year-old Malay male presented with a progressive ulcerating nodular lesion on his left medial forearm, which had been treated for a pyogenic cutaneous in...

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Published in:Brunei International Medical Journal (BIMJ) Vol. 21; pp. 165 - 170
Main Authors: SEOW, Chu Ee, ISMAIL, Nur Izreena, HUSIN, Haryati, JAMIL, Adawiyah, ARUMUGAM, Mohan, YONG, Chong Guang, TUMIAN, Nor Rafeah
Format: case study pictorial Journal Article
Published: Brunei International Medical Journal 2025
Online Access:View this record in EBSCOhost
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      jtl: Brunei International Medical Journal (BIMJ)
      issn: 15605876
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      dt: 2025
      vid: 21
      pid: 67948
      pub: Brunei International Medical Journal
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        190925812
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        atl: Delayed Recognition of Primary Cutaneous Anaplastic Large Cell Lymphoma Mimicking Pyogenic Infection: A Lesson from Primary Care.
      aug:
        au:
          SEOW, Chu Ee
          ISMAIL, Nur Izreena
          HUSIN, Haryati
          JAMIL, Adawiyah
          ARUMUGAM, Mohan
          YONG, Chong Guang
          TUMIAN, Nor Rafeah
        affil: Department of Internal Medicine, Banting Hospital, Banting, Selangor, Malaysia
      sug:
        subj:
          Forearm Pathology
          Pyoderma Diagnosis
          Diagnosis, Differential
          Skin Neoplasms Diagnosis
          Lymphoma, Large-Cell, Anaplastic Diagnosis
          Diagnosis, Delayed
          Male
          Adult
          Immunohistochemistry
          Positron-Emission Tomography
          Lymphoma, Large-Cell, Anaplastic Drug Therapy
          Methotrexate Therapeutic Use
          Lymphoma, Large-Cell, Anaplastic Radiotherapy
          Treatment Outcomes
          Adult: 19-44 years
          Male
      ab: Early-stage cutaneous lymphoma often mimics non-malignant skin disorders, leading to common misdiagnoses and delays in appropriate treatment. A 44-year-old Malay male presented with a progressive ulcerating nodular lesion on his left medial forearm, which had been treated for a pyogenic cutaneous infection with three different courses of oral antibiotics. The patient even attempted selftreatment with traditionally prepared chalk powder. On the fourth visit to the primary care clinic, a referral to the dermatology clinic was made. A biopsy was done, and histopathology and immunohistochemistry studies of the skin lesion were suggestive of anaplastic lymphoma kinase (ALK) negative anaplastic large cell lymphoma (ALCL). Staging of the disease showed that it was limited to an early stage without systemic involvement. The cutaneous lymphoma in this case was successfully treated with radiotherapy after the failure of oral methotrexate. Early recognition of pc-ALCL is important to avoid delayed treatment. This case highlights the need for greater awareness among primary care physicians of unusual but important dermatological disorders, particularly cutaneous malignancies. Misdiagnosis can impair the patient-doctor relationship and reduce patient compliance with treatment.
      pubtype: Academic Journal
      doctype:
        case study
        pictorial
        Journal Article
      ougenre: Article
    language: English
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