HPI: A 56 year old white male presented in consultation for evaluation of multiple lesions on his face, trunk, and extremities and prior biopsy concerning for cutaneous T cell lymphoma. Lesions appeared 1 year prior to presentation, initially with single lesion on forehead that patient suspected was due to spider bite and that resolved after 2-3 months. Subsequently patient noticed additional lesions, first on left toes, that spread to trunk, extremities, and face. Patient initially presented to an outside dermatologist who obtained a shave biopsy of a lesion on back and prescribed clobetasol 0.05% ointment. Lesions did not respond to clobetasol 0.05% ointment, histopathology demonstrated collections of atypical lymphocytes within the epidermis staining for CD3 with an elevated CD4:CD8 ratio and diminished CD7 expression, consistent with CTCL, MF type. Review of systems significant for 40 pound unintentional weight loss over prior 4 months, otherwise non contributory. Prior to presentation for consultation, non-contrast chest CT scan was obtained and demonstrated no evidence of lymphadenopathy. CBC, CMP, and ANA were within normal limits.
Past Medical History: Type II diabetes mellitus, hypertension, hyperlipidemia, transient ischemic attack (two events)
Family History: No known family history of lymphoma
Allergies: No known drug allergies
Medications: Vitamin D3, Metformin HCl, Ranitidine HCl, Aspirin, Atorvastatin, Atenolol, Clopidogrel Bisulfate, Lisinopril, Alprazolam, Zolpidem Tartrate
Social History: No tobacco use
Physical Exam: On examination there were multiple 5-9 mm violaceous edematous papules on chest, abdomen (Figure 1) and back, as well as a crop of 5-9 mm violaceous edematous papules on left flank (Figure 2).
Click here for diagnosis.