Abstract

Mycosis Fungoides (MF) is the most common cutaneous T-cell lymphoma. Patients with MF often experience a prolonged course of chronic disease progression over many years with only a small subset of patients developing systemic disease with lymph node and/or visceral involvement. We present a case of a 38-year-old black male with a several year history of patch stage MF who rapidly developed innumerable pink to violaceous plaques, cutaneous nodules, and tumors over several months. On examination he had extensive involvement of the face, trunk, and extremities with biopsy proven tumor stage MF. Imaging & PET further revealed countless hypermetabolic cutaneous nodules, mediastinal, hilar, and axillary lymphadenopathy, and multiple bilateral solid enlarging pulmonary nodules with bilateral pleural effusions. Given concern for infection, a lung biopsy was performed.  Flow cytometry performed on skin, lymph node, and pleural fluid were positive for the abnormal T-cell population and lung biopsy confirmed visceral involvement by MF. Treatment options for this patient include systemic therapies (including cytotoxic chemotherapy, brentuximab vedotin, and HDACi) with eventual allogeneic bone marrow transplantation. We report this case of MF with lymph node and pulmonary involvement to further characterize the advanced stages of this disease and rare visceral involvement.