Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature

Abstract

A purpuric eruption may be an unusual early manifestation of mycosis fungoides (MF). On the other hand, persistent pigmented purpuric dermatoses (PPPD) may, occasionally, evolve to cutaneous T-cell lymphoma. Coexistence of these two conditions has been reported, but it is extremely rare. We present the case of an elderly woman with a long-standing pruritic, pigmented purpuric eruption. On 1-year follow-up, histological features suggesting early MF were observed and molecular analysis of the rearrangement of T-cell receptor genes revealed clonality. Our patient may represent a case of PPPD evolving to MF, a case of MF clinically featuring PPPD, or an intermediate condition in a nosological continuity extending from PPPD to MF. A persistent pigmented purpuric eruption may rarely be a harbinger of cutaneous T-cell lymphoma. Therefore, vigilant long-term follow-up of PPPD is highly recommended.

Lichen Aureus

“…In fact, purpuric lesions resembling LA histopathologically have been described in MF. [4][5][6] An association between PPPD and MF has been reported in the context of cases of PPPD progressing to MF [7][8][9] or the presence of purpura in lesions of MF. 10 In a study of many cases of PPPD, Toro and coworkers 11 suggest that this condition may be related to MF.…”

“…21 Treatment in our patients varied, including local corticosteroid use, surgical excision, light therapy, and no treatment, but persistence or resolution of skin lesions was unrelated to the type of therapy. Given the reported possible association with MF, [7][8][9][10][11] patients with PPPD or LA should be treated according to schemes efficacious for both diseases.…”

Mycosis fungoides and Sézary syndrome: clinical, histopathological and immunohistochemical review and update

“…However, there is histological evidence of classic MF, such as band-like infiltrate in the superficial dermis, epidermotropism of atypical lymphocytes and lymphocyte alignment in the basal layer, which help with differential diagnosis from lichen aureus, nummular eczema or pharmacodermias that show purpuric conditions. 43 …”

Rare Skin Tumours in Childhood: Review

“…Zaman zaman pigmente purpurik dermatoz düşündüren deri lezyonları bulunabilir. 35,36 Bazı hastalarda tüm deri yüzeyi infiltre, skuamlı veya skuamsız kalın kırmızı deri ile kaplı ve yer yer sağlam deri adaları bulunabilir ve eritrodermiye dönüşebilir.…”