Erythrodermic Psoriasis With Anasarca and Lymphadenopathy Mimicking Lymphoma.

A 25-year-old man with chronic psoriasis presented with progressive erythroderma, anasarca with a reported 30-lb weight gain, and bulky lymphadenopathy, raising concern for lymphoma. Lymph node biopsy showed dermatopathic lymphadenopathy, and expert review of skin specimens favored an inflammatory process over cutaneous T-cell lymphoma. Low-dose methotrexate was started, followed by patient-reported improvement in function, edema, and skin changes. This case emphasizes recognizing severe inflammatory skin disease as a possible contributor to systemic illness and correlating the clinical presentation with pathology. Improvement after methotrexate supports clinical benefit but is not diagnostic of psoriasis.