A Man with Worsening Scaling Plaques and a New Onset Large Draining Ulcerated Tumor
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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.
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