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mycosis fungoides, large-cell transformation, psoriasis, pyoderma gangrenosum, deep fungal infection, brentuximab vedotin
Mycosis Fungoides (MF) is the most common form of cutaneous T-cell lymphoma, a rare condition which typically presents with erythematous patches and plaques, skin nodules and/or tumors. Advanced disease may progress to a more aggressive form known as a large-cell transformation (LCT). MF may be easily confused for psoriasis, a deep fungal infection, and pyoderma gangrenosum. Psoriasis and MF share common features associated with the abnormal functioning of T cells, and in the absence of an infectious process, pyoderma gangrenosum (PG) may be considered. Definitive diagnosis relies upon histopathology revealing characteristic features of MF including cerebriform nuclei, intraepidermal Pautrier microabscesses, epidermotropism and haloed lymphocytes, ruling out the other etiologies. Here is a case of a 62-year-old male with an atypical case of MF with LCT who presented with worsening skin eruption and a large draining ulcerated abdominal plaque. MF is typically a slow and indolent disease with multiple treatment options. Brentuximab vedotin (BV) is a monoclonal antibody targeting the CD30 antigen on cancer cells and is increasingly used in the treatment of MF patients with LCT. The patient was referred to hematology/oncology where further workup revealed CD30 positive large T-cells. He was started on BV and has already shown signs of significant disease regression.
2. Herrmann JL, Hughey LC. Recognizing large-cell transformation of mycosis fungoides. J Am Acad Dermatol. 2012;67(4):665-672.
3. Mycosis Fungoides - NORD (National Organization for Rare Disorders). Accessed March 12, 2022. https://rarediseases.org/rare-diseases/mycosis-fungoides/
4. A diagnostic challenge: Mycosis fungoides or psoriasis. J Am Acad Dermatol. 2013;68(4):AB143.
5. Diakomopoulos A, Dalamaga M, Papadavid E. Understanding the enigmatic association between mycosis fungoides and psoriasis: Report of two cases and review of the literature. Metabolism Open. 2021;12:100148.
6. Vaudreuil AM, Stroud CM, Hsu S. Psoriasis mimicking mycosis fungoides clinically. Dermatology Online Journal. 2017;23(5). doi:10.5070/D3235034934
7. Gonzalez Santiago TM, Pritt B, Gibson LE, Comfere NI. Diagnosis of deep cutaneous fungal infections: correlation between skin tissue culture and histopathology. J Am Acad Dermatol. 2014;71(2):293-301.
8. Powell FC, Su WPD, Perry HO. Pyoderma gangrenosum: classification and management. J Am Acad Dermatol. 1996;34(3):395-409. doi:10.1016/S0190-9622(96)90428-4
9. Goggins CA, Gocke MT, Jang S, DeSimone JA. Oral mycosis fungoides with CD30 + large cell transformation successfully treated with brentuximab vedotin. JAAD Case Rep. 2019;5(2):180-183.