Mycosis Fungoides

Mycosis Fungoides

MEDICAL IMAGES Mycosis Fungoides Barry Ladizinski, MD, and Elise A. Olsen, MD From the Department of Dermatology, Cutaneous Lymphoma Research and Tre...

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MEDICAL IMAGES

Mycosis Fungoides Barry Ladizinski, MD, and Elise A. Olsen, MD From the Department of Dermatology, Cutaneous Lymphoma Research and Treatment Center, Duke University Medical Center, Durham, NC.

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57-year-old man presented with a worsening, painful facial ulcer and intensely itchy rash. He was previously diagnosed with cutaneous lupus erythematosus, but treatment with chloroquine, hydroxychloroquine, mycofenolate mofetil, acitretin, thalidomide, and prednisone was ineffective. Cutaneous examination revealed a large ulcerated plaque on the right cheek (Figure 1) and scattered erythematous plaques with rolled borders on the trunk and extremities (Figure 2). Testing for antinuclear antibody was negative, and results for anti-double stranded DNA were within normal limits. A biopsy of a plaque on the right arm showed an atypical lymphocytic infiltrate, consistent with cutaneous Tcell lymphoma (CTCL), mycosis fungoides type. T-cell receptor gene rearrangement studies detected a clonal population. A form of non-Hodgkin lymphoma, CTCL is associated with cutaneous infiltration of malignant T lymphocytes. Mycosis fungoides is the most common subtype of CTCL. Our patient responded well to total body electron beam radiation therapy and has sustained his response with interferon alfa maintenance therapy. Contributions: Both authors contributed equally to the development of this manuscript.

FIGURE 1. Large ulcerated plaque on the right cheek.

FIGURE 2. Scattered erythematous plaques on the trunk and extremities.

Mayo Clin Proc. n March 2013;88(3):e27 n http://dx.doi.org/10.1016/j.mayocp.2012.12.009 www.mayoclinicproceedings.org n ª 2013 Mayo Foundation for Medical Education and Research

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