Peripheral blood abnormality in Sezary Syndrome with bacteremia

Introduction: Sezary syndrome defined as a set of symptoms consist of erythroderma, generalized lymphadenopathy, and Sezary cells were detected in peripheral blood, skin and lymph nodes. Case: Patients with chief complaints red and scaly patches cover almost part of the body accompanied by itching since 1 week ago. The patient had history of taking herbal medicines 2 weeks earlier. There is an erosion and crusting at inferior lips. There is also fissure at left side ventral hand region. There is no generalized lymphadenopathy. The patient has fever, hypertension and hyperglycemia. The laboratory result showed leukocytosis with Sezary cells > 1000 cells/mm3, and bacteremia (coccus). Differential diagnosis of patients was Sezary syndrome, drug-induced erythroderma and mycosis fungoides. The diagnosis was Sezary syndrome because erythroderma and Sezary cells > 1000 cells/ mm3 were found. The patient was treated with injection of corticosteroid, antibiotic, barrier repair moisturizer and potent topical corticosteroid. Conclusion: Sezary syndrome is often accompanied by bacteremia due to impaired skin barrier function and decreased cellular immunity. Examination of biopsy, bacterial culture and flow cytometer is required for diagnosis.