Abstract
We describe two unique cases of fulminant mycosis fungoides with remarkably similar and aggressive clinical courses resulting in death. Both cases demonstrated ulcerated palmar and periorbital plaques and marked tissue eosinophilia, which was confirmed by T-cell receptor γ chain gene rearrangement studies to display identical monoclonality at temporally and anatomically distinct sites. Dense eosinophilic infiltrates on biopsy led to misdiagnosis of inflammatory dermatoses in both instances.While mycosis fungoides may be challenging to diagnose histologically, the presence of eosinophils in progressive disease may herald a poor prognosis and should not exclude the diagnosis.
Highlights
Mycosis fungoides (MF) and its most common variants, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin, compose slightly less than half of cutaneous lymphomas [1]
Comfort care was recommended and the patient expired. Both cases demonstrate an unusual variant of aggressive plaque stage MF with a heavy infiltration of tissue eosinophils, manifesting with acrally-distributed ulcerative plaques, notable periorbital involvement, and eventual nodal metastases
Both patients were initially misdiagnosed with inflammatory dermatoses
Summary
Mycosis fungoides (MF) and its most common variants, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin, compose slightly less than half of cutaneous lymphomas [1]. Studies suggest that as MF progresses from early (patch and plaque) to advanced (tumor, erythroderma, and Sezary syndrome) stage disease, tissue eosinophils become more prominent [15,16,17,18]. We describe two cases of plaque stage MF with marked tissue eosinophilia that followed an impressively similar and aggressive clinical course.
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