Vesiculobullous Eruption in Patient With Mycosis Fungoides

Area of Science:

• Dermatology
• Oncology
• Pathology

Background:

• Mycosis fungoides is the most common cutaneous T-cell lymphoma.
• Mycosis fungoides bullosa is a rare variant characterized by vesiculobullous lesions.
• Less than 40 cases of mycosis fungoides bullosa have been reported.

Purpose of the Study:

• To report a case of mycosis fungoides bullosa in a patient with advanced folliculotropic mycosis fungoides.
• To highlight the clinical and histopathologic features of this rare subtype.
• To emphasize the importance of recognizing mycosis fungoides bullosa due to its poor prognosis.

Main Methods:

• Clinical examination of a 66-year-old female with worsening cutaneous involvement.
• Punch biopsy of skin lesions.
• Histopathologic analysis including immunophenotyping (CD3+, CD4+, CD5-, CD7-, CD30+).
• Direct immunofluorescence and blood cultures to exclude other causes.

Main Results:

• The patient presented with large, erythematous, crusted, eroded plaques with tense bullae.
• Histopathology revealed atypical CD3+ lymphocytes with epidermotropism (CD4:CD8 ratio 8:1), loss of CD5/CD7, and scattered CD30+ cells.
• Diagnosis of mycosis fungoides bullosa was confirmed after excluding infection and autoimmune diseases.

Conclusions:

• Mycosis fungoides bullosa is a rare, aggressive variant of mycosis fungoides.
• Diagnosis requires characteristic clinical lesions, histopathology, and exclusion of other blistering conditions.
• Early recognition is critical as mycosis fungoides bullosa is associated with a poor prognosis, with high mortality within one year of bullae onset.