Dermatose eosinofílica paraneoplásica simulando prurigo nodular como manifestação inicial de linfoma de células B em idoso
Paraneoplastic eosinophilic dermatosis mimicking prurigo nodularis as the initial manifestation of B-cell lymphoma in an older adult
Bruno Emanuel Carvalho Oliveira; Mirella Dantas Fulco; Maíra Medeiros Pacheco de-Andrade
Resumo
O prurido crônico é uma queixa prevalente entre idosos e, quando refratário ao tratamento, pode indicar doenças sistêmicas subjacentes, incluindo neoplasias hematológicas. Este artigo descreve o caso de um paciente de 81 anos com prurido intenso de seis meses de duração, acompanhado de lesões nodulares disseminadas e eosinofilia periférica. A biópsia cutânea inicial foi compatível com prurigo nodular, mas a ausência de melhora clínica levou à realização de nova biópsia associada à imunofenotipagem, que revelou infiltrado dérmico com predomínio de eosinófilos e presença de população clonal de linfócitos B com forte expressão de CD20, confirmando linfoma de células B maduras. O diagnóstico final foi de dermatose eosinofílica como manifestação paraneoplásica do linfoma. A discussão aborda a fisiopatologia multifatorial do prurido senil, incluindo alterações na barreira cutânea, disfunções imunológicas com polarização Th2 e papel inflamatório dos eosinófilos, que podem atuar como células apresentadoras de antígenos não convencionais e mediadores teciduais. As dermatoses eosinofílicas paraneoplásicas, embora raras e frequentemente subdiagnosticadas, são manifestações clínicas importantes em hematopatias malignas e podem simular dermatoses benignas como o prurigo nodular. O reconhecimento dessas apresentações atípicas é essencial para o diagnóstico precoce. Conclui-se que quadros de prurido crônico refratário em idosos devem ser abordados com alta suspeição clínica e investigação ampliada. A atuação conjunta de especialistas em alergologia, dermatologia e hematologia foi decisiva para a elucidação diagnóstica e definição terapêutica. O diagnóstico precoce de síndromes paraneoplásicas pode m
Palavras-chave
Abstract
Chronic pruritus is a common complaint among older adults and, when refractory to treatment, may indicate underlying systemic diseases, including hematologic neoplasms. This article presents the case of an 81-year-old patient with intense pruritus lasting 6 months, accompanied by disseminated nodular lesions and peripheral eosinophilia. The initial skin biopsy was consistent with prurigo nodularis; however, the absence of clinical improvement prompted a repeat biopsy with immunophenotyping, which revealed a dermal infiltrate predominantly composed of eosinophils and a clonal population of B lymphocytes with strong CD20 expression, confirming mature B-cell lymphoma. The final diagnosis was eosinophilic dermatosis as a paraneoplastic manifestation of lymphoma. The discussion addresses the multifactorial pathophysiology of senile pruritus, including impairment of the skin barrier, immune dysregulation with Th2 polarization, and the inflammatory role of eosinophils, which may act as unconventional antigen-presenting cells and tissue mediators. Paraneoplastic eosinophilic dermatoses, although rare and often underdiagnosed, are important clinical manifestations of malignant hematologic disorders and may mimic benign dermatoses such as prurigo nodularis. Recognition of these atypical presentations is essential for early diagnosis. It can be concluded that cases of chronic refractory pruritus in older adults should prompt a high index of clinical suspicion and a comprehensive diagnostic workup. Multidisciplinary collaboration among allergists, dermatologists, and hematologists was crucial for diagnostic clarification and treatment decision-making. Early diagnosis of paraneoplastic syndromes may alter the clinical course and improve patient prognosis.
Keywords
Referências
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Submetido em:
24/05/2025
Aceito em:
07/08/2025
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