Case 57

A 53-year-old man presented with pruritic skin rash over his forearms and trunk with low-grade fever for two weeks. The patient was born in Japan and migrated to the United States when he was 20 years old. Physical examination revealed generalized lymphadenopathy and splenomegaly. Peripheral blood examination showed a total leukocyte count of 13,000/μl with 85% lymphocytes, 13% neutrophils, and 2% monocytes. His hematocrit was 45%, hemoglobin 14.5 g/dl, and platelets 195,000/μl. Further examination of the peripheral blood smear found that about 20% of the lymphocytes showed atypical morphology (Fig. 57.1). A skin biopsy was performed (Figs. 57.2 and 57.3).