Sir, CD8+ mycosis fungoides (MF) is a rare form of MF with an indolent course. Herein, we report a rare case of CD8+ fungoid mycosis preceded by lymphomatoid papulosis type D with an aggressive course. A 36-year-old female presented with several papular lesions on the trunk and extremities with a relapsing–remitting course. Histopathology and an immunohistochemical study confirmed CD8-positive lymphomatoid papulosis type D and methotrexate at 25 mg/week was initiated. After a temporary clinical improvement, the lesions worsened, became infiltrated, and grouped as vaguely annular and angular patches with serpiginous borders (Fig. 1). A second scalp biopsy was performed and a diagnosis of CD8+ MF was established. An extension workup was normal, and MF was classified as stage IB. PUVA therapy was started with acitretin at 25 mg/day. After four weeks from the beginning of treatment, the patches completely disappeared but with the concomitant appearance of four subcutaneous tumors. The evolution was spectacular in fifteen days, with the tumors rapidly increasing in size, becoming ulcerative and necrotic, and one being localized in the left cervical area compressing the upper respiratory tract (Fig. 2). A subsequent biopsy revealed massive epidermal and dermal large cell infiltration (Fig. 3a); the tumor cells were positive for CD3, CD8, and CD7 (Fig. 3b) and negative for CD4, CD5, CD3, CD2, and CD30. Antigen Ki-67 was expressed by more than 80% of T-cells (Fig. 3c). A cerebral and thoraco-abdominal CT scan revealed multiple axillary lymph nodes with hypermetabolism on a PET scan. An osteomedullar biopsy was normal, and lactate dehydrogenase (LDH) was increased to 358 U/L. Chemotherapy was performed, but the patient died after two cycles of CHOEP. In contrast to classical CD4+ mycosis fungoides, CD8+ MF is a rare cytotoxic phenotype constituting about 5% of all cases of MF [1]. It belongs to the first group of primary cytotoxic cutaneous lymphomas (PCCL) with a good prognosis, an indolent course, and a slow progression of the lesions over several years [2]. However, rare cases with a more aggressive course have been reported in the literature [3]. The main differential diagnosis of aggressive CD8+ MF is an aggressive epidermotropic cutaneous CD8+ lymphoma that is a rare cutaneous lymphoma with a poor prognosis due to rapid extracutaneous dissemination [4]. The prognosis of the CD8+ subtype of mycosis fungoides (MF) is controversial. More studies are necessary to clarify this subject.
A 34-year-old Moroccan female presented with a painless, firm, slow-growing tumor on the second left toe for the past two years with the involvement of the nail and matrix. A physical examination showed a firm, skin-colored tumor 3 cm in diameter, which had raised and displaced the nail (Fig. 1). Dermoscopic features included a yellowish hyperkeratotic finger-like projection (Fig. 2a), areas with a total white scar-like patch, and linear vessels (Fig. 2b).
Calcinosis cutis is a condition in which calcium salts are deposited in the skin and subcutaneous tissue. It may be associated with connective tissue disease and rarely with lupus disease. We report a historical case of extensive calcinosis cutis universalis secondary to Systemic Lupus Erythematosus (SLE) associated with lupus panniculitis.
IMAGE ARTICLECheck for updates constitute a heterogeneous group of connective tissue disorders and may be associated with connective tissue diseases. We report a historical case of extensive calcinosis cutis universalis secondary to Systemic Lupus Erythematosus (SLE) associated with lupus panniculitis.
ObservationWe report the case of a 37-year-old woman with SLE associated with lupus panniculitis diagnosed in the year 2000. Ten years after diagnosis, she spontaneously developed several isolated, hard, erythematous, and
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