Figure 1. Generalized erythoderma in a patient with Sézary syndrome-a triad of erythroderma, lymphadenopathy and circulating neoplastic lymphocytes. Patients often experience intense itching and loss of body heat through skin.
Figure 2. Blood smear stained with Giemsa showing Sézary cell with convoluted nucleus. Sézary cells may be confused with monocytes which are of similar size and have a folded nucleus. Further distinction is facilitated by Periodic-acid-Schiff (PAS) stain which shows coarse granules surrounding the nucleus in cytoplasm of Sézary cells and fine dispersed granules in monocytes. Flow cytometry will also identify Sézary cells as T cells which express surface CD3 and CD4, but commonly lack CD7 antigen.