Mycosis fungoides with photosensitivity mimicking chronic ac
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A 50-year-old lady presented with complaints of asymptomatic gradually progressive red raised lesions over face and upper limbs of 5 years duration with intermittent exacerbation on exposure to sunlight. Patient had been treated in the past with multiple courses of oral and topical steroids, sunscreens, and tablet hydroxychloroquine with suboptimal response.

Present examination revealed multiple discrete hyperpigmented to violaceous papules and plaques over forehead, dorsum of both hands, and forearms in a photo-distributed pattern.

Skin biopsy from a representative lesion was performed, which showed dense dermal lymphoid infiltrate in the background of acanthosis, dermal fibroplasia, and focal epidermotropism. The infiltrate was composed of atypical lymphoid cells showing nuclear membrane irregularity and moderate nuclear pleomorphism. Pautrier's microabscess in the epidermis by these atypical lymphocytes was noted without spongiosis.

On immunohistochemistry, these atypical cells showed positivity for CD3 and CD4 immunostain, thus confirming T-cell origin. Routine haematological investigations including peripheral blood smear and biochemistry was normal and whole-body PET scan did not reveal any subclinical metastasis.

The patient was diagnosed as a case of mycosis fungoides (Clinical stage 1a) and managed with PUVA phototherapy with topical steroid application.

Source: https://www.idoj.in/article.asp?issn=2229-5178;year=2021;volume=12;issue=2;spage=337;epage=339;aulast=Sinha
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