Case Number : Case 2344 - 11 June 2019 Posted By: Uma Sundram

mycosis fungoides

Yes, first thought MF.

ATLL is another possibility (If the patient is HTLV1 positive of course) 

Epidermotropism, Pautrier

microabscesses and possibly empty underbelly sign. MF! 

Erythrodermic mycosis fungoides.  If circulating sezary-cells—>SS. 

This patient could have erythrodermic MF (classical clinical history of MF progression should help to diagnosis), Sézary (if laboratory findings correlate with it) or an Erythrodermic PCTCL, if both the above diagnosis are not confirmed. We can not forget the possibility of pseudolymphomatous T-cell drug reaction, so it is important to see the medications this patient is using.

epidermotropic lymphocytes

IHC is needed to know and clinical information on any drug which can being this

Great comments. The things to ask the clinician about include: 1) duration of erythroderma 2) presence of alopecia, ectropion, acral keratoderma 3) lymph adenopathy 4) circulating Sézary  cells with abnormal immunophenotype. The patient has had erythroderma for more than a year, alopecia and palmoplantar keratoderma, lymphadenopathy, and abnormal circulating cells with Sézary  morphology and CD7-CD26- phenotype. No pre existing patches and plaques of MF. The combined clinical and pathologic findings qualify for the diagnosis of Sézary  syndrome.

Great case Uma! Thanks.