Folliculotropic Mycosis Fungoides

摘要

Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides characterized by the presence of folliculotropic infiltrates, often with sparing of the epidermis, and preferential involvement of the head and neck. We report a case with classical FMF lesions but also with a deep ulcer, which is an unusual presentation. Abbreviations: MF- Mycosis Fungoides, Introduction Folliculotropic mycosis fungoides has been designated as a distinct entity in the World Health Organization-European Organization for Research and Treatment of Cancer classification system for cutaneous lymphomas. 1 It usually involves the scalp and face but may also compromise the torso, as in our patient. Its clinical spectrum includes scarring and nonscarring alopecias, erythematous plaques with follicular accentuation, acneiform lesions such as nodulocystic lesions, pustules, milia and comedones; tumors and sometimes mucinous discharge. Severe pruritus is also a prominent feature.2 Case Report A 62-year-old man presented with a 20 year history of a pruritic erythematous rash on his scalp and trunk previously diagnosed as seborrheic dermatitis and eosinophilic folliculitis. He had eosinophilia (13%) and IgE significantly elevated (2317 K/UL). He was initially treated with antifungals, topical steroids, antihistaminics and oral antibiotics with partial improvement. This past last year, he developed a slowly growing ulceration in the middle of his back. Physical examination revealed (Figure 1A) an erythematous plaque with scarring alopecia on his scalp and (Figure 1B) erythematous telangiectatic patches and plaques on the trunk. Micropustules were seen within some of these lesions. (Figure 1C). On the back, he had a large 4x3 cm. ulcer down to the muscle containing purulent drainage (Figure 1D) and had palpable axillary and inguinal nodes. The cultures grew Staphylococcus aureus. Biopsies were performed of the edge of the ulcer, of the anterior chest surrounding a pustule and of a lymph node.