Mycosis fungoides masquerading as an ischemic foot

This case is of a man with bilateral lower-extremity ischemia and a solitary nonhealing ulcerated lesion of the right great toe. After revascularization with an aortobifemoral bypass, his right ABI increased from 0.5 to approximately 0.75, but the ulcerated toe lesion did not show signs of healing and instead progressed to a deeper ulceration exposing bone. Because of presumptive osteomyelitis, we performed a great toe amputation, and immunohistochemical analysis of the lesion revealed late plaque stage mycosis fungoides (MF). We present this case to alert the vascular surgeon to this diagnostic possibility when confronted with an apparent ischemic lesion and to describe what made this particular lesion suspicious for MF. To the best of our knowledge, this is the first case of MF presenting solely as an ischemic lesion.