Cutaneous granulomatous reaction as the first manifestation of Hodgkin's lymphoma

A 33-year-old male was referred to our department with a three-month history of weakness, nonproductive cough and asymptomatic skin lesions of both legs. His medical history included asthma that was medicated with montelukast, budesonide and formoterol. A physical examination showed confluent erythematous annular plaques, circumferentially distributed on both legs and associated with edema (Figure 1). No hepatomegaly, splenomegaly nor lymphadenopathy were palpable. A biopsy specimen of a cutaneous plaque revealed a lymphohistiocytic infiltrate with a non-necrotizing granulomatous pattern involving the dermis and subcutaneous tissue