When Pityriasis Versicolor wears a vitiligo mask: a puzzle in an immunocompromised patient

A 47-year-old male with a history of colonic adenocarcinoma and recent chemotherapy presented with persistent hyperpigmentation of the trunk, initially thought to be vitiligo due to the striking hyperpigmented lesions and well-demarcated hypopigmented skin. Histological examination of the hyperpigmented lesions, originally thought to represent normal skin, revealed findings consistent with lichen planus pigmentosus. Due to the clinical-histological discordance, a Scotch test was performed, which identified fungal elements consistent with pityriasis versicolor (PV). Treatment with oral fluconazole resulted in rapid resolution of symptoms, highlighting the importance of reconsidering initial diagnoses when clinical and investigative findings are discordant and the efficacy of timely antifungal therapy.