Authors: Sarah Faye V. Obbus, Eileen Liesl A. Cubillan


Introduction: Folliculotropic mycosis fungoides (MF) is an uncommon and aggressive variant of MF. It usually takes months to years before this condition is diagnosed because of its nonspecific presentation. Secondary xanthomatization, on the other hand, has been reported to arise from different inflammatory skin diseases including mycosis fungoides.

Case Summary: We report a case of a 47 year old male who presented with a 4 year history of erythematous pruritic papules on the face, scalp, trunk and extremities gradually enlarging to become nodules and plaques, with one lesion becoming a yellowish tumor. Application of topical steroids only temporarily improved the lesions. Biopsy done on the forehead plaque and back papule showed dense infiltrates of lymphocytes and numerous eosinophils surrounding and infiltrating hair follicles. CD3 stain was positive, while CD20 negative. Biopsy done on the right cheek yellowish tumor showed diffuse infiltrates of foamy macrophages and scattered lymphocytes. CD68 was diffusely positive. There was also a higher proportion of CD3+ lymphocytes than CD20+. Chest x-ray, complete blood count, peripheral blood smear and lipid profile were all unremarkable. Patient was for abdominal CT-scan for complete staging before possible total skin electron beam therapy, but was lost to follow up.

Conclusion: Folliculotropic MF can present variedly both clinically and histologically, hence should be a differential for recurrent and nonresponsive eczematous lesions. There should be a low threshold for biopsy, ideally with multiple sites biopsied, as this is a variant which can be aggressive if not diagnosed promptly.






folliculotropic mycosis fungoides, xanthomatization, mycosis fungoides

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