Unraveling Subcutaneous Panniculitis-like T-cell Lymphoma (SPTCL): An Association between SPTCL, Autoimmune Lymphoproliferative Syndrome (ALPS), and Familial Hemophagocytic Lymphohistiocytosis (HLH).

LeBlanc, Robert E; Lansigan, Frederick

Germline HAVCR2 mutations, recently identified in a large subset of patients with subcutaneous panniculitis-like T-cell lymphoma (SPTCL), are associated with an increased risk of hemophagocytic lymphohistiocytosis (HLH). Discovery of this heritable HLH/SPTCL diathesis has expanded our understanding of a rare and molecularly heterogeneous lymphoma. Furthermore, patients with SPTCL have excellent survival unless they develop HLH. Therefore, through compiling data on SPTCL-related conditions that predispose patients to HLH, we are better able to predict which patients with SPTCL have the greatest risk of mortality. We present the first case of SPTCL with concomitant HLH and autoimmune lymphoproliferative syndrome (ALPS) in a patient who was subsequently diagnosed with familial HLH (F-HLH) attributable to a germline STXBP2 splice-site mutation. She had wildtype HAVCR2. Reports including ours demonstrate how SPTCL can evolve in the setting of an exaggerated host inflammatory response attributable to a variety of unusual underlying etiologies. This article is protected by copyright. All rights reserved.