10.5826/dpc.1303a179
text/xml
2160-9381
2919
en
Trilokraj  Tejasvi 
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Purpuric Plaques on Extremities - a Unique Presentation of Mycosis Fungoides Palmaris et Plantaris
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-10-17
2023-07-31
2023-08-24
e2023179
Dermatol Pract Concept
Trilokraj  Tejasvi 
2023/07/31
10.5826/dpc.1303a179
e2023179
Department of Dermatology, University of Michigan School of Medicine, University of Michigan; Ann Arbor Veteran Affairs, Ann Arbor, Michigan, USA
2160-9381
en
e2023179
McNiff JM, Schechner JS, Crotty PL, Glusac EJ. Mycosis fungoides palmaris et plantaris or acral pagetoid reticulosis? Am J Dermatopathol. 1998;20(3):271-275. DOI: 10.1097/00000372-199806000-00009. PMID: 9650701.
Purpuric Plaques on Extremities - a Unique Presentation of Mycosis Fungoides Palmaris et Plantaris
https://dpcj.org/index.php/dpc/article/download/2919/2219
          Purpuric Plaques on Extremities - a Unique
          Presentation of Mycosis Fungoides Palmaris
                          et Plantaris
           Nicole Trupiano1, Daniel Wenzel2, Alexandra C. Hristov2,3, Trilokraj Tejasvi2,4


1 University of Michigan Medical School, Ann Arbor, Michigan, USA
2 Department of Dermatology, University of Michigan School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
3 Department of Pathology, University of Michigan School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
4 Ann Arbor Veteran Affairs, Ann Arbor, Michigan, USA



Citation: Trupiano N, Wenzel D, Hristov AC, Tejasvi T. Purpuric Plaques on Extremities - A Unique Presentation of Mycosis Fungoides
Palmaris et Plantaris. Dermatol Pract Concept. 2023;13(3):e2023179. DOI: https://doi.org/10.5826/dpc.1303a179
Accepted: April 1, 2023; Published: July 2023
Copyright: ©2023 Trupiano et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Trilokraj Tejasvi, MD, Department of Dermatology, University of Michigan, 1910 Taubman Center, 1500 E.
Medical Center Drive, Ann Arbor Veteran Affairs, Ann Arbor, MI 48109. Phone: 734-936-4054 Fax: 734-647-6593
Email: ttejasvi@med.umich.edu




Case Presentation                                                        Teaching Point
A 61-year-old female presented with a 3-year history of a rash           For MFPP, CD4+ is usually predominant and CD8+ is rare [1,2].
with purpuric involvement in the plantar and palmar areas                Other variants of cutaneous T-cell lymphoma (CTCL) have
without any involvement of the dorsum of the foot or hands               been reported to have CD8 involvement, including pagetoid
(Figure 1). Medical history was significant for Crohn disease            reticulosis (PR), Ketron-Goodman disease, Hypopigmented
and breast cancer. Patient was not taking anti-coagulants.               mycosis fungoides (MF), and Woringer-Kolopp disease [2].
Previous treatments included topical steroids with little                     Histology proved to be a major distinguishing factor for
improvement. She denied constitutional symptoms. Der-                    this patient; MFPP is known for its atypical dermal infiltrate
moscopy revealed multiple red brown streaks with parallel                [1,2]. Atypical cells are rarely seen within the dermis in PR,
furrow pattern as well as multiple linear vessels, admixed               but were present in this patient in a band-like distribution in
with white lines at the periungual area (Figure 1). Biopsies             the superficial dermis in this patient [2]. Topical steroids have
of the right palm and toe revealed an epidermotropic T-cell              been proven to be effective in early stages of MFPP and radi-
lymphoma most consistent with CD8+ mycosis fungoides                     ation therapy has been proven to be successful in other cases
palmaris et plantaris (MFPP) (Figure 1). Extravasated eryth-             of refractory MFPP [1]. Although slightly different than the
rocytes were found in the superficial dermis, epidermis and              traditional CD4+ MFPP described in these cases, this patient
cornified layer.                                                         cleared her lesions with four sittings of low dose radiation.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023179                                                                              1
Figure 1. Clinical presentation, dermoscopy and histology. (A) Well circumscribed, scaly, mildly eroded purpuric plaques were noted on her
distal fingertips and lateral fingers. There was subungual erythema and swelling with some peeling of the skin.(B) Well circumscribed, scaly,
mildly eroded purpuric plaques were noted on her lateral toes and tips of her toes. On the right medial toe, there was a 2 cm red-brown,
hyperkeratotic plaque with scale. (C) Involving the proximal nailfold, cuticle and lateral nailfolds, there are multiple red brown streaks with
parallel furrow pattern as well as multiple ill-defined linear vessels, admixed with white lines at the periungual area.(D) Shave biopsy shows
an atypical lymphoid infiltrate filling the papillary dermis and extend into the basilar epidermis as individual cells and small collections
(original magnification X100).



References                                                                2. McNiff JM, Schechner JS, Crotty PL, Glusac EJ. Mycosis fun-
                                                                              goides palmaris et plantaris or acral pagetoid reticulosis? Am J
 1. Nakai N, Hagura A, Yamazato S, Katoh N. Mycosis fungoides                 Dermatopathol. 1998;20(3):271-275. DOI: 10.1097/00000372-
    palmaris et plantaris successfully treated with radiotherapy:             199806000-00009. PMID: 9650701.
    case report and mini-review of the published work. J Derma-
    tol. 2014;41(1):63-67. DOI: 10.1111/1346-8138.12308. PMID:
    24438146.




2                                                                                Image Letter | Dermatol Pract Concept. 2023;13(3):e2023179
