Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma initially demonstrating near-complete metabolic response to BV-CHEP

Dear Editors,

A previously healthy 63-year-old male was referred to our tertiary dermatology clinic with a 6-month history of a disseminated pruritic, weeping rash. Prior biopsies of skin lesions and bacterial swabs demonstrated spongiotic dermatitis and chronic folliculitis with methicillin-susceptible Staphylococcus aureus, suggesting concomitant folliculitis and eczema. The patient was initially managed as infected eczema with multiple courses of oral antibiotics and topical corticosteroids.

However, the patient’s cutaneous eruption failed to improve and continued to evolve rapidly into ulcerated plaques and tumor-like nodules. Clinical examination showed erythematous plaques with crusting and folliculitis on his scalp. A polymorphic eruption was observed on the trunk and limbs, consisting of impetiginized, crusted follicular- and non-follicular-based papules and plaques, erosions, ecthyma-like plaques, and eczematous plaques. Intertriginous eroded ulcerated plaques with overlying slough were seen in his groin folds and axillae. Large nodules occupied his submental space and right axilla (Figure 1).