SHM Converge Scientific Abstract ePoster Gallery-The Great Imitator: Cutaneous T Cell Lymphoma Misdiagnosed as Eczema

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This case report describes a 42-year-old woman with a 5-year history of biopsy-proven eczema that ultimately proved to be cutaneous T-cell lymphoma (CTCL), specifically mycosis fungoides (MF). Her condition worsened despite topical steroids and Dupixent, and she developed increasing eosinophilia, body pain, skin ulcerations, fever, and tachycardia. Initial infectious workup showed methicillin-sensitive Staphylococcus aureus in blood and wound cultures, but persistent fevers and eosinophilia raised concern for an underlying malignancy.<br /><br />Further evaluation supported CTCL: blood flow cytometry showed a large CD4 T-cell population with loss of CD7, suggestive of a T-cell neoplasm. Sezary smear and peripheral smear were negative, but skin and inguinal lymph node biopsies confirmed mycosis fungoides. Bone marrow biopsy was negative for lymphoma, while PET imaging demonstrated extensive hypermetabolic skin lesions and lymphadenopathy consistent with diffuse lymphomatous involvement. She was treated with gemcitabine and wound care, with gradual improvement.<br /><br />The report emphasizes that MF is a common subtype of CTCL and can closely mimic benign inflammatory skin diseases such as eczema and psoriasis, leading to delayed diagnosis. Eosinophilia may occur in both severe eczema and CTCL, making differentiation difficult. However, treatment-refractory eczema, persistent eosinophilia, and especially B symptoms or progressive skin lesions should prompt evaluation for malignancy. A multidisciplinary approach using skin biopsy, blood flow cytometry, imaging, and lymph node assessment is key to confirming diagnosis and guiding treatment.

Asset Subtitle

Jessica Igiede

Meta Tag

Author List Jessica Igiede, Melissa Gunchenko, Vida Ehyaee

Category Clinical Vignettes

Concept Cutaneous T-Cell Malignancy

Concept Mycosis Fungoides

Concept Skin Biopsy

Concept Eczema

Concept Blood Flow Cytometry

Distinguished Non-Finalist

Presenter Organization Rush Medical College

Presenting Author Jessica Igiede

Track Adult

Keywords

cutaneous T-cell lymphoma

mycosis fungoides

eczema mimic

eosinophilia

biopsy-proven eczema

CD4 T-cell population

loss of CD7

PET imaging

lymphadenopathy

gemcitabine

Cutaneous T-Cell Malignancy

Mycosis Fungoides

Skin Biopsy

Eczema

Blood Flow Cytometry