Erythrodermic Cutaneous T-Cell Lymphoma: A Great Imitator? Unmasking Its Clinical and Histopathological Clues

Abstract

Background: Both erythrodermic mycosis fungoides (E-MF) and Sézary syndrome are considered forms of erythrodermic cutaneous T-cell lymphoma (CTCL). Erythrodermic CTCL is a term used to describe CTCL subtypes that present with erythroderma as a prominent feature. Diagnosing these conditions can be challenging due to their non-specific clinical and histopathological signs. Several other skin conditions like dermatitis seborhoeic (DS), atopic dermatitis (AD), psoriasis vulgaris, and systemic diseases can present with erythroderma and similar symptoms, leading to a potential misdiagnosis or delayed diagnosis.

Case Report: We reported a case series consisted of four patients of Erythrodermic CTCL in M Djamil Hospital Padang from 2021-2023. Patient no. 1 is 85 years old male with E-MF that initially diagnosed as erythroderma ec. DS. Patient no. 2 is 65 years old male with E-MF that initially diagnosed as erythroderma ec. DS. Patient no. 3 is 70 years old male with Sézary syndrome that misdiagnosed as erythroderma ec AD and psoriasis vulgaris. Patient no. 4 is 33 years old female with Sézary syndrome that initially diagnosed as erythroderma ec. DS. All cases were confirmed with immunohistochemistry using CD3, which showed a positive result of epidermotropism.

Discussion: Establishing the etiology of erythrodermic CTCL poses a challenge. A thorough examination must be conducted to establish the diagnosis, including comprehensive histopathological examination and immunohistochemistry.