CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
This article is part of the Research TopicCase-based Advances in the Understanding of Rare and Unusual Hematologic Malignancies 2025View all articles
Enteropathy-Associated T-Cell Lymphoma Presenting as Refractory Cutaneous Ulcers in a 28-Year-Old Male: A Case Report and Literature Review
Provisionally accepted
- 1The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- 2Department of Medical Imaging, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
- 3Department of Pathology, Beijing Chaoyang Integrated Traditional Chinese and Western Medicine Emergency Rescue Center, Beijing, China
- 4Department of Hematology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
- 5Department of Vascular Surgery, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Background: Enteropathy associated T-cell lymphoma (EATL) is a rare and aggressive subtype of peripheral T-cell lymphoma, most commonly associated with celiac disease (CD). It typically presents with gastrointestinal symptoms and carries a poor prognosis. Cutaneous involvement as the initial manifestation, particularly in the form of refractory skin ulcers in young patients, is rare. Case Summary: We report a 28-year-old male who presented with a one-year history of refractory, non-healing ulcers on the right foot and several years of chronic diarrhea, initially misdiagnosed and treated as a chronic infection in April 2019. Despite multiple antibiotic regimens, surgical debridement, and immunosuppressive therapy, the lesions progressed symmetrically to involve the right hand and left thigh. The patient underwent amputation of the right lower limb and right hand in October 2020. One month later, the patient developed acute peritonitis secondary to jejunal perforation. Laparotomy revealed a transmural tumor mass, and histopathological and immunohistochemical analyses confirmed EATL (CD3+/CD103+/TIA-1+/GRANB+, CD5-/CD8-, Ki-67 ~70%). The patient died of multiorgan failure three weeks postoperatively in December 2020. Conclusion: This case underscores that EATL may manifest with widespread cutaneous ulcers more than one year before the onset of severe gastrointestinal symptoms. In patients with chronic diarrhea and refractory skin ulcers, celiac disease should be excluded, while cutaneous lesions should be recognized as potential paraneoplastic manifestations of an underlying lymphoma. Diagnostic delays—driven by anchoring bias and insufficient tissue sampling—are critical contributors to advanced disease at presentation and poor clinical outcomes.
Keywords: Enteropathy-Associated T-Cell Lymphoma, Cutaneous ulcer, Celiac Disease, Paraneoplastic syndrome, Misdiagnosis, Young patients, case report
Received: 30 Sep 2025; Accepted: 07 Nov 2025.
Copyright: © 2025 Zhao, Li, Liu, Xu, Liu, Zhao, Cheng and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ming Liu, liuming404@163.com
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