Mycosis fungoides is a cutaneous T-cell lymphoma, arising from peripheral epidermotropic T-cells that express a CD4+ immunophenotype, with a high CD4/CD8 ratio. Initially manifesting as patches, the condition progresses into infiltrated plaques and can eventually lead to tumor formations. Double positive immunophenotypes, although rare, could be considered as potential predictors for better survival rates. Environmental exposure to radiation and chemicals, along with other risk factors, may be potentially linked to the development of Mycosis fungoides. We present a 74-year-old female with potentially henna-induced Multicentric Mycosis Fungoides type tumor d’emblee, staged T3N0M0B1 lA. Immunohistochemistry and flow cytometry revealed a double positive immunophenotype CD4+/CD8+. Throughout her routine follow-ups, two biopsies were conducted to confirm the diagnosis, with several changes of the therapeutic regimen, all resulting in disease progression. On her latest follow-up, we recommended initiating therapy with methotrexate. We will briefly review the clinical presentation and treatment approaches for a rare and treatment-resistant case of MF, with a primary focus on two newly emerged hypotheses: 1) the significance of double immunophenotypes as prognostic indicators, and 2) the potential chemical contamination of henna with different carcinogens / mutagens and its subsequent role in MF development and progression. Key words: multicentric mycosis fungoides; tumor d’emblee; double positive immunophenotype; henna dye; tattoos; methotrexate
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