SHM Converge Scientific Abstract ePoster Gallery-Dual Aggression: A Rare Case of Mycosis Fungoides and High-Grade B-Cell Lymphoma

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This case describes a rare and severe coexistence of mycosis fungoides (a cutaneous T-cell lymphoma) and high-grade B-cell lymphoma in a 73-year-old man with a history of mycosis fungoides, bladder cancer, and hypertension.<br /><br />He was admitted in March 2024 with worsening left arm swelling, dizziness, fever, and lethargy. Laboratory findings showed marked leukocytosis (WBC 40,000/µL), very high inflammatory and tissue injury markers (CRP 217 mg/L, LDH 1,774 U/L), acute kidney injury (creatinine 197 µmol/L), hypercalcemia (2.83 mmol/L), and severe lactic acidosis (lactate 9.4 mmol/L). Imaging revealed extensive mediastinal, axillary, retroperitoneal, and upper abdominal lymphadenopathy, suggesting aggressive lymphoproliferative disease. Flow cytometry confirmed high-grade B-cell lymphoma, indicating a possible composite lymphoma occurring alongside his known cutaneous T-cell lymphoma, which had presented as a red flaky rash.<br /><br />His condition rapidly deteriorated, requiring ICU admission for shock, metabolic acidosis, and acute kidney injury. He was intubated and started on continuous renal replacement therapy (CRRT), but despite vasopressors and intensive supportive care, he developed multi-organ failure, worsening lactic acidosis, liver dysfunction, and refractory shock.<br /><br />The report highlights that simultaneous mycosis fungoides and B-cell lymphoma is uncommon but associated with poor outcomes. Patients with mycosis fungoides are at higher risk for secondary hematologic malignancies because of chronic immune dysregulation. Treatment is challenging because therapies for one malignancy may be ineffective or potentially worsen the other. Clinicians should maintain a high index of suspicion for secondary lymphoma in mycosis fungoides patients who develop systemic symptoms, leukocytosis, or metabolic derangements. A multidisciplinary approach and early recognition are essential.

Asset Subtitle

Zahrah Alhomedi

Meta Tag

Author List Bassel Jallad, Mahra Almheiri, Saaid Abdel-Ghani, Zahrah Alhomedi

Category Clinical Vignettes

Concept Mycosis Fungoides

Concept High-Grade B-Cell Lymphoma

Concept Secondary Hematologic Malignancy

Concept B-Cell Lymphoma

Concept Aggressive Lymphoproliferative Disease

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic AbuDhabi

Presenting Author Zahrah Alhomedi

Track Adult

Keywords

mycosis fungoides

cutaneous T-cell lymphoma

high-grade B-cell lymphoma

composite lymphoma

lymphadenopathy

leukocytosis

lactic acidosis

acute kidney injury

shock

multi-organ failure

Mycosis Fungoides

High-Grade B-Cell Lymphoma

Secondary Hematologic Malignancy

B-Cell Lymphoma

Aggressive Lymphoproliferative Disease