according the latest iteration of the who classification , subcutaneous panniculitis - like t - cell lymphoma(sptcl ) is refer to  t - cell derivation cytotoxic tumor . multiple subcutaneous nodules of varying size or necrotic , mostly located on the trunk , and extremities , may be misdiagnosed as panniculitis because of it 's deceptively benign appearance . sptcl affects both man and women with a broad age range , but rarely in children younger than 2 years . some literatures about the treatment of sptcl have been published , but no scheme was involved in relapsed sptcl . a 25-year - old man presented with a 1-month history of recurrent , multiple , reddish skin lesions and nodules on the anterior chest surface together with low - grade fever , general fatigue and anorexia . a deep punch biopsy of a nodule from the anterior chest verified the diagnosis of sptcl , immunohistochemistry showed the neoplastic cells were positive for : lca , cd3 , cd8 , granzyme b , and perforin , and negative for cd56 and cd20 . the symptions improved in 4 days and disappeared in 1 week after prednisone 90 mg daily was given intermittently -which maintained 3 weeks and was tapered off in 6 weeks . but the same lesions and nodules was founded in the same location with 4-kg weight loss eight months after the termination of prednisone . the patient was admitted to our hospital with the examination of pale , and febrile(temperature of 39c ) . local skin examination revealed multiple erythematous , tender , and firm subcutaneous nodules of variable size ( 11.5 cm ) on the anterior chest . physical examination , chest x ray , ct scan of abdomen , and bone marrow studies , revealed no other site involvement . laboratory investigations showed pancytopenia , an elevated erythrocyte sedimentation rate ( 66 mm / h ) , normal renal function tests , abnormal hepatic function tests ( alanine aminotransferase 188 u / l , aspartate aminotransferase 236 u / l , alkaline phosphatase 635 u / l , total bilirubin 98 mol / l , conjugated bilirubin 22 mol / l , and high triglycerides 465 mg / dl . , 48 sec . respectively ; fibrinogen is 74 mg / dl ; and positive fibrinogen degradation products were also noted . serologic tests for syphilis , hiv , and hepatitis b and c viruses were negative . a diagnosis of sptcl together hps was made and a choep recipe -cyclophosphamide [ 750 mg / m , intravenously ( i.v . ) , doxorubicin ( 50 mg / m i.v . ) , vincristine ( 2 mg i.v . ) all given on day 1 and prednisone ( 90 mg / day per os ) given on days 15 , etoposide 100 mg / m i.v . on days fever and skin lesions resolved within 2 weeks after the treatment but relapsed in 1 week later . then prednisone was removed ( tapered off in 1 month ) and only cyclosporine a 200 mg was taken every day . after 1 month , this patient was discharged with all the systemic symptoms and skin lesions resolved . the patient 's condition remained in remission at 12-month follow - up with a normal blood count ; there was no evidence of clinical relapse . the distinctive clinicopathological features of a t - cell lymphoma involving the subcutaneous tissue were firstly described by gonzalez in 1991 . it have been identified that it 's drived from cytotoxic t lymphocytes and named sptcl in the revised european american classification of lymphoid neoplasms . two distinct subtypes of sptcl have been classified by the cellular origins :  and  t - cell derivation . now , sptcl is specially refer to the cytotoxic tumor of  t - cell derivation . in sptcl , subcutaneous fat is involved that make panniculitis - like appearance . morphologically , the lymphoma infiltrate involves the lobules of the subcutaneous tissue , resulting in a typical lobular - panniculitis - like pattern . the lymphoma cells are small to medium in size with moderate pale cytoplasm ; the nuclei are round to irregular and often hyperchromatic . the neoplastic cells are generally confined to subcutaneous tissue and frequently infiltrate individual fat cells with a rim - like arrangement at the cell border . tumor cells are most often cd8 cytotoxic lymphocytes expressing one or more cytotoxic granule proteins including tia-1 , granzyme b , and perforin and the  tcr . manifestations of systemic involvement are fever , hepatosplenomegaly , mucosal ulcers and sometimes serosal effusions . the clinic course may present in an indolent manner but to be aggressive when the hemophagocytic syndrome(hps ) happen . hps , a presenting feature in 37% of patients with sptcl , is characterized by fever , cytopenia , splenomegaly , abnormal liver function , and the pathologic finding of hemophagocytosis ( phagocytosis of erythrocytes , leukocytes , platelets , and their precursors bymacrophages ) in bone marrow . the appearance of hps was thought to be related to cytokine and chemokine production by the malignant cells , perhaps in a setting of comprised cytolytic function . this patient have pancytopenia , liver function abnormalities , hepatosplenomegaly , pleural effusion , hypertriglyceridemia , and coagulopathy , in keeping with the diagnosis of relapsed sptcl complicated by hps . treatments such as systemic chemotherapy , radiotherapy , stem cell transplantation and limb amputation have been used since this disease described . first of all , systemic steroids or other immunosuppressive agents should be applied in sptcl without associated hps , whereas radiotherapy should be considered in cases of solitary skin lesions . multi - agent chemotherapy may be required in cases with progressive disease not responding to immunosuppressive therapy or in cases with hps , but anthracycline - based combination chemotherapy ( chop or chop - like ) were reported to be with unsatisfactory result . other materials , such as denileukin diftitox , a recombinant fusion protein that combines human interleukin 2 and diphtheria toxin , have been applied on sptcl with challenging outcome . prednisone have been applied on sptcl with optimistical result although some still be invalid . in this patient , prednisone made a period of 8 months tumor release but be ineffective ultimately . even hps , a syndrome was reported can be cureed by prednisone , emerging at the eighth month of the application of prednisone , proved the treatment was aborted . chop together with etoposide , another cytostatic drug which was verified to be effective to hps , so called choep , made no significant effect . cyclosporine , a calcineurin inhibitor , is a potent immunosuppressant that reduces the production of several growth factors . in spite of the significantly worse prognosis of sptcl complicated by hps , cyclosporine the mechanism of action of cyclosporin in sptcl is also down - regulation of cytokines . in this patient , cyclosporine ( 200 mg / d ) made the symptoms improved within 1 week and resolved in 1 month . there is not standard treatment to sptcl because of the rarity of the disease , especially to relapsed phase . this report suggest that cyclosporine a may be still an effictive therapy when this disease relapsed .