Abstract
Cutaneous T cell lymphoma (CTCL) is a group of lymphoproliferative disorders comprised of monoclonal primarily CD4+ derived malignant T-cells. CTCL can often mimic other benign processes which contributes to delayed diagnosis and initiation of treatment. Furthering this delay is the fact that many treatments that are likely to be initiated for these mimickers, including nbUVB and topical steroids, also provide some relief for CTCL. The median time from onset of disease before correct diagnosis is made is 2.27 years and often requires multiple biopsies. One of the more common CTCL mimickers includes atopic dermatitis (AD). With the widespread use of dupilumab for AD, there have been several reports in the literature of dupilumab associated CTCL. It is unclear whether dupilumab exacerbates underlying CTCL that has been misdiagnosed as AD or that the drug promotes malignant transformation. A recent review identified twenty-three cases of patients with AD treated with dupilumab who subsequently developed pathology-confirmed CTCL. Two cases which support the latter theory were patients with long standing history of childhood AD and pre-dupilumab biopsies consistent with AD. Of the adult-onset AD cases, only 5 cases had pre-dupilumab biopsies consistent with AD. All other cases had an unclear association. Here we present a small case series of three patients treated with dupilumab presumably for AD, with subsequent flaring of their CTCL from eczematous patch and plaque stage into three different morphologies: nodules and tumors, erythroderma, and hands only. This case series emphasizes the importance of re-biopsying any atypical recalcitrant dermatitis.