www.cureus.com
Open in
urlscan Pro
2606:4700:10::ac43:805
Public Scan
URL:
https://www.cureus.com/articles/97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma
Submission: On March 13 via manual from IN — Scanned from DE
Submission: On March 13 via manual from IN — Scanned from DE
Form analysis 4 forms found in the DOM
<form accept-charset="UTF-8">
<div class="not-logged-in">Please <a>sign in</a> or <a>sign up</a> to comment.</div>
</form>POST /publish/articles/97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma/send_sign_up_email?source=PDFDownload
<form id="pdf-email-form" action="/publish/articles/97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma/send_sign_up_email?source=PDFDownload" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input
type="hidden" name="authenticity_token" value="2/2YFC0v3HuRx5LLsu9Nx9VnobnS1o0m64RVllKqZ3+WO+g/L91XCR0ggAdburRK/N6bYvAAU9LLYafSEfdZAA==">
<div class="large-8 large-offset-1 medium-8 medium-offset-1 columns">
<input type="email" name="email" id="email" required="required">
</div>
<div class="large-1 medium-1 columns end">
<input type="submit" name="commit" value="send" class="button special" id="pdf-download-button" data-disable-with="send">
</div>
</form>POST /users/sign_in?id=97019&open_comments=true&return_to=%2Farticles%2F97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma
<form class="new_user" id="new_user" action="/users/sign_in?id=97019&open_comments=true&return_to=%2Farticles%2F97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma" accept-charset="UTF-8" method="post"><input name="utf8"
type="hidden" value="✓"><input type="hidden" name="authenticity_token" value="2/2YFC0v3HuRx5LLsu9Nx9VnobnS1o0m64RVllKqZ3+WO+g/L91XCR0ggAdburRK/N6bYvAAU9LLYafSEfdZAA==">
<div class="form-label-input-wrap no-label no-padding">
<div class="text-wrap">
<label>Sign in with your email address:</label>
</div>
</div>
<div class="form-label-input-wrap">
<label class="email-label" for="user_email">Email</label>
<div class="input-wrap">
<input required="required" autofocus="autofocus" type="email" name="user[email]" id="user_email">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_password">Password</label>
<div class="input-wrap">
<input required="required" type="password" name="user[password]" id="user_password">
</div>
</div>
<input value="true" type="hidden" name="user[remember_me]" id="user_remember_me">
<div class="form-label-input-wrap no-label no-padding">
<div class="devise-submit-wrap">
<input type="submit" name="commit" value="Sign in" class="button primary large input-wrap" data-disable-with="Sign in">
</div>
</div>
</form>POST /registrations?article_id=97019&return_to=%2Farticles%2F97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma&user_type=comment
<form class="new_user" id="continue_registration" data-parsley-validate="true" action="/registrations?article_id=97019&return_to=%2Farticles%2F97019-dermatophytosis-incognito-mimicking-cutaneous-t-cell-lymphoma&user_type=comment"
accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓"><input type="hidden" name="authenticity_token" value="2/2YFC0v3HuRx5LLsu9Nx9VnobnS1o0m64RVllKqZ3+WO+g/L91XCR0ggAdburRK/N6bYvAAU9LLYafSEfdZAA==">
<div class="form-label-input-wrap">
<label for="user_first_name">First name</label>
<div class="input-wrap">
<input autofocus="autofocus" required="required" tabindex="1" type="text" name="user[first_name]" id="user_first_name">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_last_name">Last name</label>
<div class="input-wrap">
<input autofocus="autofocus" required="required" tabindex="2" type="text" name="user[last_name]" id="user_last_name">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_email">Email</label>
<div class="input-wrap">
<input required="required" autofocus="autofocus" tabindex="3" type="email" name="user[email]" id="user_email">
</div>
</div>
<div class="form-label-input-wrap">
<label for="user_password">Password</label>
<div class="input-wrap">
<input required="required" tabindex="4" type="password" name="user[password]" id="user_password">
</div>
</div>
<div class="form-label-input-wrap">
<label class="text control-label" for="user_specialty_id">Specialty</label>
<div class="input-wrap">
<select required="required" name="user[specialty_id]" id="user_specialty_id">
<option value="">Please choose</option>
<option selected="selected" value="361">I'm not a medical professional.</option>
<option value="2">Allergy and Immunology</option>
<option value="357">Anatomy</option>
<option value="3">Anesthesiology</option>
<option value="237">Cardiac/Thoracic/Vascular Surgery</option>
<option value="249">Cardiology</option>
<option value="283">Critical Care</option>
<option value="360">Dentistry</option>
<option value="10">Dermatology</option>
<option value="284">Diabetes and Endocrinology</option>
<option value="13">Emergency Medicine</option>
<option value="246">Epidemiology and Public Health</option>
<option value="21">Family Medicine</option>
<option value="363">Forensic Medicine</option>
<option value="285">Gastroenterology</option>
<option value="371">General Practice</option>
<option value="47">Genetics</option>
<option value="352">Geriatrics</option>
<option value="368">Health Policy</option>
<option value="369">Hematology</option>
<option value="281">HIV/AIDS</option>
<option value="282">Hospital-based Medicine</option>
<option selected="selected" value="361">I'm not a medical professional.</option>
<option value="286">Infectious Disease</option>
<option value="353">Integrative/Complementary Medicine</option>
<option value="27">Internal Medicine</option>
<option value="362">Internal Medicine-Pediatrics</option>
<option value="314">Medical Education and Simulation</option>
<option value="219">Medical Physics</option>
<option value="370">Medical Student</option>
<option value="287">Nephrology</option>
<option value="59">Neurological Surgery</option>
<option value="177">Neurology</option>
<option value="60">Nuclear Medicine</option>
<option value="364">Nutrition</option>
<option value="61">Obstetrics and Gynecology</option>
<option value="367">Occupational Health</option>
<option value="267">Oncology</option>
<option value="69">Ophthalmology</option>
<option value="372">Optometry</option>
<option value="359">Oral Medicine</option>
<option value="70">Orthopaedics</option>
<option value="358">Osteopathic Medicine</option>
<option value="73">Otolaryngology</option>
<option value="354">Pain Management</option>
<option value="355">Palliative Care</option>
<option value="78">Pathology</option>
<option value="114">Pediatrics</option>
<option value="291">Pediatric Surgery</option>
<option value="135">Physical Medicine and Rehabilitation</option>
<option value="143">Plastic Surgery</option>
<option value="351">Podiatry</option>
<option value="146">Preventive Medicine</option>
<option value="162">Psychiatry</option>
<option value="244">Psychology</option>
<option value="288">Pulmonology</option>
<option value="213">Radiation Oncology</option>
<option value="207">Radiology</option>
<option value="289">Rheumatology</option>
<option value="366">Substance Use and Addiction</option>
<option value="225">Surgery</option>
<option value="365">Therapeutics</option>
<option value="356">Trauma</option>
<option value="239">Urology</option>
<option value="150">Miscellaneous</option>
</select>
</div>
</div>
<div class="row">
<div class="large-12 columns">
<h4 class="reg">Email Communication and Personal Data</h4>
</div>
</div>
<div class="row">
<div class="large-1 medium-1 small-1 columns">
<input name="user[email_preference][gdpr_verify]" type="hidden" value="0"><input required="required" name="user[email_preference][gdpr_verify]" type="checkbox" value="1" id="user_gdpr_verify">
</div>
<div class="large-11 medium-11 small-11 columns">
<label for="user_gdpr_verify">Cureus personal data will never be sold to third parties and will only be used to enrich the user experience and contact you in direct relation to the application. I agree to opt in to this communication.</label>
</div>
</div>
<div class="form-label-input-wrap recaptcha-centered modal">
<script src="https://www.recaptcha.net/recaptcha/api.js" async="" defer=""></script>
<div data-sitekey="6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG" class="g-recaptcha ">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.recaptcha.net/recaptcha/api2/anchor?ar=1&k=6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG&co=aHR0cHM6Ly93d3cuY3VyZXVzLmNvbTo0NDM.&hl=de&v=MuIyr8Ej74CrXhJDQy37RPBe&size=normal&cb=58abzy301jgv" width="304"
height="78" role="presentation" name="a-s55s1kl5p2s0" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div>
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<noscript>
<div>
<div style="width: 302px; height: 422px; position: relative;">
<div style="width: 302px; height: 422px; position: absolute;">
<iframe src="https://www.recaptcha.net/recaptcha/api/fallback?k=6LdWUksUAAAAADUnX2rBGTOHw17gZ-8NmKyvEDzG" name="ReCAPTCHA" style="width: 302px; height: 422px; border-style: none; border: 0; overflow: hidden;">
</iframe>
</div>
</div>
<div style="width: 300px; height: 60px; border-style: none;
bottom: 12px; left: 25px; margin: 0px; padding: 0px; right: 25px;
background: #f9f9f9; border: 1px solid #c1c1c1; border-radius: 3px;">
<textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid #c1c1c1;
margin: 10px 25px; padding: 0px; resize: none;"> </textarea>
</div>
</div>
</noscript>
</div>
<div class="form-label-input-wrap no-label-new modal">
<p class="text-wrap submit-text-wrap modal"> By joining Cureus, you agree to our <a href="/privacy">Privacy Policy</a> and <a href="/terms">Terms of Use</a>. </p>
</div>
<div class="form-label-input-wrap no-label modal">
<div class="devise-submit-wrap modal">
<input type="submit" name="commit" value="Sign up" class="button primary large input-wrap modal" data-disable-with="Sign up">
</div>
</div>
</form>Text Content
* Home
* Journal
* Back
* Journal
* Articles
* People
* Posters
* Specialties
* Back
* Specialties
* Allergy/Immunology
* Anatomy
* Anesthesiology
* Cardiac/Thoracic/Vascular Surgery
* Cardiology
* Dentistry
* Dermatology
* Emergency Medicine
* Endocrinology/Diabetes/Metabolism
* Environmental Health
* Epidemiology/Public Health
* Family/General Practice
* Forensic Medicine
* Gastroenterology
* General Surgery
* Genetics
* Geriatrics
* Healthcare Technology
* Health Policy
* Hematology
* HIV/AIDS
* Infectious Disease
* Integrative/Complementary Medicine
* Internal Medicine
* Medical Education
* Medical Physics
* Medical Simulation
* Miscellaneous
* Nephrology
* Neurology
* Neurosurgery
* Nuclear Medicine
* Nutrition
* Obstetrics/Gynecology
* Occupational Health
* Oncology
* Ophthalmology
* Oral Medicine
* Orthopedics
* Osteopathic Medicine
* Otolaryngology
* Pain Management
* Palliative Care
* Pathology
* Pediatrics
* Pediatric Surgery
* Physical Medicine & Rehabilitation
* Plastic Surgery
* Podiatry
* Preventive Medicine
* Psychiatry
* Psychology
* Public Health
* Pulmonology
* Quality Improvement
* Radiation Oncology
* Radiology
* Rheumatology
* Sports Medicine
* Substance Use and Addiction
* Therapeutics
* Transplantation
* Trauma
* Urology
* Publishing
* Back
* Publishing
* About Publishing
* Article Promotion
* Author & Reviewer Guides
* Preferred Editing Service
* Article Sharing Guide
* SIQ™ (Scholarly Impact Quotient™)
* Channels
* Back
* Channels
* Academic Departments
* Back
* Academic Departments
* Alabama College of Osteopathic ...
* Annals of Simulation
* Aurora Breast Health Proceedings
* Baylor Scott & White Medical Ce ...
* California Institute of Behavio ...
* Contemporary Reviews in Neurolo ...
* Dalhousie Emergency Medicine
* DMIMS School of Epidemiology an ...
* FLAGSHIP: Medical Scholarly Pro ...
* Howard University Internal Medicine
* Jawaharlal Nehru Medical College
* Liberty Medicine Research Channel
* Med-Peds Academic Channel
* Military Medical Simulation
* Modern Medical Educator
* NB Social Pediatrics Research
* NEMA Research Group
* NYC Health + Hospitals/Woodhull
* Paolo Procacci Foundation
* Penn State Neurosurgery
* Research Update Organization
* SBH Health System
* Simulation, Biodesign, & Innova ...
* Sinai Chicago Research
* Stanford Neurosurgery
* The Florida Medical Student Res ...
* UCSF Surgical Neuroanatomy Coll ...
* University of Florida-Jacksonvi ...
* University of Louisville Neuros ...
* University of Munich Neurology
* VCOM Clinical, Biomedical, and ...
* Professional Societies
* Back
* Professional Societies
* ACOS Cardiothoracic and Vascula ...
* ACOS General Surgery
* ACOS Neurological Surgery
* ACOS Plastic and Reconstructive ...
* ACOS Urological Surgery
* Advanced Sciences Academic Channel
* American Red Cross Scientific A ...
* Annals of Health Innovation
* BioLEAGUES
* Canadian Association of Radiati ...
* International Liaison Committee ...
* International Pediatric Simulat ...
* Japan Radiosurgery Society
* Medical Society of Delaware Aca ...
* Society for Healthcare & Resear ...
* the Radiosurgery Society
* About Channels
* Competitions
* Back
* Competitions
* Current
* Back
* Current
* Surgically Targeted Radiation Th...
* Archived
* Back
* Archived
* Automated Whole Brain Tractography
* Clinical and Economic Benefits o...
* Clinical Applications and Benefi...
* Defining Health in the Era of Va...
* Exceptional Responders in Breast...
* Exceptional Responders in Oncology
* Frameless Stereotactic Radiosurgery
* Intraoperative Fluorescence Rese...
* Investigational Cardiac Radiosur...
* MR-Guided Radiation Therapy: Cli...
* Multiple Brain Metastases: Excep...
* Negative Pressure Wound Therapy ...
* NPWT with Instillation and Dwell...
* Optimization Strategies for Orga...
* Proton Therapy: Advanced Applica...
* Radiation Therapy as a Modality ...
* Strategies to Promote Long-Term ...
* About Competitions
* Newsroom
* Back
* Newsroom
* All Posts
* News
* Cureus U
* Newsletters
* About
* Back
* About
* Editorial Board
* Associate Editors
* Academic Council
* Wall of Shame
* About Cureus
* Cureus Honors
* Careers
* Advertising & Sponsorship
* Partnerships
* ISSN #2168-8184
*
*
* Sign In
* Create an Account
> "Never doubt that a small group of thoughtful, committed citizens can change
> the world. Indeed, it is the only thing that ever has."
>
> Margaret Mead
SUBMIT RESEARCH
* Journal
Articles
People
Posters
Specialties
* Allergy/Immunology
* Anatomy
* Anesthesiology
* Cardiac/Thoracic/
Vascular Surgery
* Cardiology
* Dentistry
* Dermatology
* Emergency Medicine
* Endocrinology/Diabetes/
Metabolism
* Environmental Health
* Epidemiology/Public Health
* Family/General Practice
* Forensic Medicine
* Gastroenterology
* General Surgery
* Genetics
* Geriatrics
* Healthcare Technology
* Health Policy
* Hematology
* HIV/AIDS
* Infectious Disease
* Integrative/Complementary Medicine
* Internal Medicine
* Medical Education
* Medical Physics
* Medical Simulation
* Miscellaneous
* Nephrology
* Neurology
* Neurosurgery
* Nuclear Medicine
* Nutrition
* Obstetrics/Gynecology
* Occupational Health
* Oncology
* Ophthalmology
* Oral Medicine
* Orthopedics
* Osteopathic Medicine
* Otolaryngology
* Pain Management
* Palliative Care
* Pathology
* Pediatrics
* Pediatric Surgery
* Physical Medicine & Rehabilitation
* Plastic Surgery
* Podiatry
* Preventive Medicine
* Psychiatry
* Psychology
* Public Health
* Pulmonology
* Quality Improvement
* Radiation Oncology
* Radiology
* Rheumatology
* Sports Medicine
* Substance Use and Addiction
* Therapeutics
* Transplantation
* Trauma
* Urology
RECENT TOP ARTICLES
--------------------------------------------------------------------------------
An Abnormal Case of Diabetic Myonecrosis: A Case Report and Review of
Literature
Improvement of Blood Parameters of Male Rats Exposed to Different Injection
Doses of Liquid Chlor...
Atypical Nelson Syndrome Following Right Partial and Left Total Nephrectomy
With Incidental Bilat...
* Publishing
* About Publishing
* Article Promotion
* Author & Reviewer Guides
* Preferred Editing Service
* Article Sharing Guide
* SIQ™ - Scholarly Impact Quotient™
* Channels
About Channels
Academic
* Alabama College of Osteopathic Medicine Research
* Annals of Simulation
* Aurora Breast Health Proceedings
* Baylor Scott & White Medical Center Department of Neurosurgery
* California Institute of Behavioral Neurosciences & Psychology
* Contemporary Reviews in Neurology and Neurosurgery
* Dalhousie Emergency Medicine
* DMIMS School of Epidemiology and Public Health
* FLAGSHIP: Medical Scholarly Proceedings
* Howard University Internal Medicine
* Jawaharlal Nehru Medical College
* Liberty Medicine Research Channel
* Med-Peds Academic Channel
* Military Medical Simulation
* Modern Medical Educator
* NB Social Pediatrics Research
* NEMA Research Group
* NYC Health + Hospitals/Woodhull
* Paolo Procacci Foundation
* Penn State Neurosurgery
* Research Update Organization
* SBH Health System
* Simulation, Biodesign, & Innovation In Medical Education
* Sinai Chicago Research
* Stanford Neurosurgery
* The Florida Medical Student Research Publications
* UCSF Surgical Neuroanatomy Collection
* University of Florida-Jacksonville Neurosurgery
* University of Louisville Neurosurgery
* University of Munich Neurology
* VCOM Clinical, Biomedical, and Educational Research
Professional Societies
* ACOS Cardiothoracic and Vascular Surgery
* ACOS General Surgery
* ACOS Neurological Surgery
* ACOS Plastic and Reconstructive Surgery
* ACOS Urological Surgery
* Advanced Sciences Academic Channel
* American Red Cross Scientific Advisory Council
* Annals of Health Innovation
* BioLEAGUES
* Canadian Association of Radiation Oncology
* International Liaison Committee on Resuscitation
* International Pediatric Simulation Society
* Japan Radiosurgery Society
* Medical Society of Delaware Academic Channel
* Society for Healthcare & Research Development
* the Radiosurgery Society
* Competitions
About Competitions
CURRENT
* Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case
Review
PAST
* Dermatology
* Clinical and Economic Benefits of Autologous Epidermal Grafting
* Cardiology
* Investigational Cardiac Radiosurgery
* General
* Defining Health in the Era of Value-Based Care
* Intraoperative Fluorescence Research
* Optimization Strategies for Organ Donation and Utilization
* Neurosurgery
* Automated Whole Brain Tractography
* Frameless Stereotactic Radiosurgery
* Oncology
* Exceptional Responders in Breast Cancer
* Exceptional Responders in Oncology
* Radiation Oncology
* MR-Guided Radiation Therapy: Clinical Applications & Experiences
* Multiple Brain Metastases: Exceptional Outcomes from Stereotactic
Radiosurgery
* Proton Therapy: Advanced Applications for the Most Challenging Cases
* Radiation Therapy as a Modality to Create Abscopal Effects: Current and
Future Practices
* Surgery
* Clinical Applications and Benefits Using Closed-Incision Negative
Pressure Therapy for Incision and Surrounding Soft Tissue Management
* Negative Pressure Wound Therapy with Instillation
* NPWT with Instillation and Dwell: Clinical Results in Cleansing and
Removal of Infectious Material with Novel Dressings
* Newsroom
* All Posts
* News
* Cureus U
* Newsletters
* About
* Editorial Board
* Associate Editors
* Academic Council
* Wall of Shame
* ISSN #2168-8184
* About Cureus
* Cureus Honors
* Careers
* Advertising & Sponsorship
* Partnerships
Cureus is on a mission to change the long-standing paradigm of medical
publishing, where submitting research can be costly, complex and
time-consuming.
John R. Adler, MD, Founder
SUBMIT RESEARCH
SIGN IN
Join Now
On May 25, 2018, the GDPR (General Data Protection Regulation) went into effect
and changed how organizations deal with personal data of customers located in
the EU. Though GDPR was built to protect Europeans, it will affect organizations
around the world doing business in the EU. Because of this we are asking our
users located in the EU to opt in to the data we collect in order to bring a
better web experience. Opt-In
-
RATED BY 1 READERS
The SIQ for this article will be revealed
once 2 ratings are submitted.
-
CLARITY OF BACKGROUND AND RATIONALE
-
CLINICAL IMPORTANCE
-
STUDY DESIGN AND METHODS
-
DATA ANALYSIS
-
NOVELTY OF CONCLUSIONS
-
QUALITY OF PRESENTATION
CONTRIBUTE RATING
Learn more about SIQ™
-
Rate Article
What's This?
--------------------------------------------------------------------------------
TABLE OF CONTENTS
--------------------------------------------------------------------------------
CATEGORIES
* Dermatology
* Infectious Disease
* Oncology
--------------------------------------------------------------------------------
KEYWORDS
ADVERTISEMENT
Peer-Reviewed
•
Case Report
•
More info
DERMATOPHYTOSIS INCOGNITO MIMICKING CUTANEOUS T-CELL LYMPHOMA
Shahab Babakoohi • Chad M. McCall
Shahab Babakoohi • Chad M. McCall
Published: June 10, 2022
DOI: 10.7759/cureus.25809
Cite this article as: Babakoohi S, McCall C M (June 10, 2022) Dermatophytosis
Incognito Mimicking Cutaneous T-Cell Lymphoma. Cureus 14(6): e25809.
doi:10.7759/cureus.25809
ADVERTISEMENT
Article
Authors etc.
Metrics
Media
Comments
ABSTRACT
Dermatophytosis incognito can be missed in diagnosis, given its relatively low
prevalence as compared with common cases of dermatophytosis and therefore, is
likely under-reported. Cutaneous T-cell lymphoma (CTCL) is also a rare entity
with variable clinical manifestations. While successful treatment of
dermatophytosis is feasible with multiple topical and systemic antifungal
options, CTCL can present a therapeutic challenge associated with significant
emotional distress for the patients. We present a case of tinea incognito
initially treated for eczema, later considered biopsy-supported CTCL that was
successfully treated with antifungal therapy.
INTRODUCTION
Dermatophytosis incognito is a condition seen in an untreated fungal
infection following the application of topical corticosteroids which may not
always manifest with typical tinea symptoms [1]. It is often inadvertently
treated as inflammatory dermatoses such as eczema prior to the correct
diagnosis. Cutaneous T-cell lymphoma (CTCL) includes a broad spectrum of
subtypes and clinical manifestations of cutaneous malignant clonal T
lymphocytes. Mycosis fungoides is the most common type [2]. CTCL can also be
misdiagnosed and treated as inflammatory dermatoses. Despite significant
diagnostic advances including cultures, special stains, and molecular pathology
in the diagnosis of these entities, clinical suspicion still plays a major role.
CASE PRESENTATION
The patient was a 62-year-old woman with a history of chronic myeloid leukemia
and polycythemia vera with myelofibrosis diagnosed in 2009; she went into
remission after a hematopoietic stem cell transplant in 2015. In 2020, she
developed a pruritic rash on the right shin with a large plaque and a small rash
on the right elbow (Figure 1). She was diagnosed with eczema and treated
with multiple lines of potent topical corticosteroids for greater than six
months. The rash, inflammation, and pruritus progressively worsened. She was
referred to oncologic dermatology.
FIGURE 1: A. RIGHT SHIN ERUPTION AT PRESENTATION; B. AFTER ONE MONTH OF
TERBINAFINE
With a clinical impression of dermatophytosis incognito, empiric ketoconazole
cream was started. Systemic treatment was deferred pending the results of
pathology, microbiology tissue cultures, and evaluation of response to topical
therapy.
Histopathology of the punch biopsy from the right shin showed an atypical
lymphoid infiltrate with small lymphocytes with irregular nuclear contours and
clear cytoplasm, which was centered in the dermis with focal evidence of
epidermotropism (Figure 2). The infiltrate extended around the adnexal
structures and blood vessels and had focal involvement of the hair follicle. A
periodic acid-Schiff (PAS) stain was negative for fungal elements. The atypical
lymphocytes were positive for CD3 and CD4 with partial loss of CD7 expression.
CD8 highlighted background T cells. CD30 was positive in very rare cells. CD20
highlighted very rare background B cells. The findings were compatible with a
diagnosis of mycosis fungoides.
FIGURE 2: A. DERMAL-BASED LYMPHOID INFILTRATE WITH FOCAL EVIDENCE OF
EPIDERMOTROPISM (H&E, 200X). B. EPIDERMAL LYMPHOCYTES WITH IRREGULAR NUCLEAR
CONTOURS AND CLEAR CYTOPLASM (ARROWS) (H&E, 400X). C. CD3 IMMUNOHISTOCHEMICAL
STAIN HIGHLIGHTING T-CELLS, WHICH ACCOUNT FOR MOST OF THE LYMPHOID INFILTRATE
(200X). D. CD4 IMMUNOHISTOCHEMICAL STAIN HIGHLIGHTING THE MAJORITY OF THE
T-CELLS, AS WELL AS DIMLY STAINING DENDRITIC CELLS AND MACROPHAGES (200X). E.
CD7 IMMUNOHISTOCHEMICAL STAIN SHOWING PARTIAL LOSS OF EXPRESSION IN THE T-CELLS
(200X). F. CD8 IMMUNOHISTOCHEMICAL STAIN SHOWING BACKGROUND CYTOTOXIC T-CELLS,
FEWER IN NUMBER THAN CD4-POSITIVE CELLS (200X).
A preliminary discussion was performed with the patient for potential treatment
options including both topical and systemic CTCL therapies given the failure of
topical corticosteroid treatment. Given the extensive history of hematologic
malignancies with complications of systemic treatments, she was unwilling to
proceed with systemic agents in case of failure of topical options.
During ongoing discussions regarding CTCL treatment, the patient reported a
notable improvement in inflammation of rash after several days of ketoconazole
cream application, thrice daily. Prior to the consideration of mycosis
fungoides-directed therapy, an oral terbinafine course was tried. T-cell
receptor gamma gene rearrangement assay returned negative for monoclonality
while receiving oral antifungal agent.
The patient reported significant improvement one week after treatment. The right
elbow rash resolved after two weeks of treatment. One month after treatment, the
right shin plaque had dramatically improved.
Tissue culture for bacterial, fungal, and atypical mycobacterial infection
remained negative. The patient did not return for further follow-up as she
reported complete resolution.
DISCUSSION
Dermatophytosis incognito is seen in untreated superficial fungal
infections treated with corticosteroids. PAS staining sensitivity varies in the
literature from 70% to 98% [3]. A negative result does not confidently exclude
the diagnosis. There are few studies on the sensitivity of tissue culture for
dermatophytes. In one study, clinical assessment was used as the gold standard
for tinea pedis. The sensitivities for KOH smear and culture were approximately
73% and 42%, respectively [4].
CTCL, a lymphoma that is generally known as a liquid tumor, has a predilection
for the skin. While it is frequently limited to the skin, it can spread into the
lymphatic system and even enter the leukemic phase known as Sezary syndrome [5].
CTCL is diagnosed by histopathology features, immunohistochemistry, and
molecular markers. In histopathology, diffuse dermal infiltrate of neoplastic
T-cells is seen [6]. Among immunophenotypical characteristics, the most common
finding is loss of CD7 expression; however, CD7 expression loss can be a
reactive phenomenon and has been reported in inflammatory benign dermatosis [7].
Accumulation of CD7 negative T-cell lymphocytes has been reported in lymphocytic
infiltrates and inflammatory skin lesions [8] Our patient did regularly shave
her legs which is a known risk factor for dermatophytosis infection in the
setting of immunosuppression. Her right elbow rash could be an
autoeczematization reaction which resolved simultaneously with the improvement
of leg eruption.
CONCLUSIONS
Mycosis fungoides and dermatophytosis incognito can have overlapping features.
Histopathology, special stains, or culture may not clearly differentiate these
two entities. Clinicians need to use their clinical skills in the diagnosis of
complex dermatoses, especially when some treatment options would be prolonged,
aggressive, or bear considerable side effects.
REFERENCES
1. Seitz AT, Paasch U, Simon JC, Ziemer M: Tinea incognito. J Dtsch Dermatol
Ges. 2013, 11:1090-3. 10.1111/ddg.12156
2. Koh HK, Charif M, Weinstock MA: Epidemiology and clinical manifestations of
cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. 1995, 9:943-60.
3. Shalin SC, Ferringer T, Cassarino DS: PAS and GMS utility in
dermatopathology: review of the current medical literature. J Cutan Pathol.
2020, 47:1096-102. 10.1111/cup.13769
4. Levitt JO, Levitt BH, Akhavan A, Yanofsky H: The sensitivity and specificity
of potassium hydroxide smear and fungal culture relative to clinical
assessment in the evaluation of tinea pedis: a pooled analysis. Dermatol Res
Pract. 2010, 2010:764843. 10.1155/2010/764843
5. Hamad H, Mangla A: Lymphocytosis. StatPearls Publishing, Treasure Island
(FL); 2022. https://pubmed.ncbi.nlm.nih.gov/31747226/.
6. Willemze R: Primary cutaneous lymphoma: the 2018 update of the WHO-EORTC
classification. Presse Med. 2022, 51:104126. 10.1016/j.lpm.2022.104126
7. Murphy M, Fullen D, Carlson JA: Low CD7 expression in benign and malignant
cutaneous lymphocytic infiltrates: experience with an antibody reactive with
paraffin-embedded tissue. Am J Dermatopathol. 2002, 24:6-16.
10.1097/00000372-200202000-00002
8. Moll M, Reinhold U, Kukel S, Abken H, Müller R, Oltermann I, Kreysel HW:
CD7-negative helper T cells accumulate in inflammatory skin lesions. J
Invest Dermatol. 1994, 102:328-32.
-
RATED BY 1 READERS
The SIQ for this article will be revealed
once 2 ratings are submitted.
-
CLARITY OF BACKGROUND AND RATIONALE
-
CLINICAL IMPORTANCE
-
STUDY DESIGN AND METHODS
-
DATA ANALYSIS
-
NOVELTY OF CONCLUSIONS
-
QUALITY OF PRESENTATION
CONTRIBUTE RATING
Learn more about SIQ™
-
RATED BY 2 READERS
Scholary Impact Quotient is our unique post-publication peer review rating
process
Read More
Contribute Article
What's This?
COMMENTS
0
* Sort By
* Oldest to Newest
* Newest to Oldest
--------------------------------------------------------------------------------
Please sign in or sign up to comment.
LOAD MORE
RELATED TOPICS
--------------------------------------------------------------------------------
eczema
terbinafine
ctcl
dermatophytosis incognito
mycosis fungiodes
ADVERTISEMENT
FURTHER READING
--------------------------------------------------------------------------------
Multisystem Inflammatory Syndrome in Adults Associated With COVID-19: A Case
Series on the Importance of Early Diagnosis and Corticosteroid Therapy in
Prognosis
Lymphangitic Carcinomatosis of Possible Urothelial Origin
Atypical Nelson Syndrome Following Right Partial and Left Total Nephrectomy With
Incidental Bilateral Total Adrenalectomy of Renal Cell Carcinoma: A Chat
Generative Pre-Trained Transformer (ChatGPT)-Assisted Case Report and Literature
Review
Statin Utilization Among Individuals Infected With Hepatitis C Virus: A
Retrospective Cohort Study
A Rare Phenomenon of Lithium-Associated Acne Inversa: A Case Series and
Literature Review
POPULAR RELATED ARTICLES
Ivermectin Prophylaxis Used for COVID-19: A Citywide, Prospective, Observational
Study of 223,128 Subjects Using Propensity Score Matching
Lucy Kerr, Flavio A. Cadegiani +7 more
Predictors of Mortality in Patients With Dengue Fever: Insights From a
Comparative Analysis
Afsheen Mahmood, Anwar ul Haq +8 more
Adult Acquired Buried Penis: A Hidden Problem in Obese Men
Philip R. Cohen
Ichthyosis Congenita, Harlequin Type: A Fatal Case Report
Amber Tahir, Syed Maaz Tariq +2 more
View More
ENTER YOUR EMAIL ADDRESS TO RECEIVE YOUR FREE PDF DOWNLOAD.
Please note that by doing so you agree to be added to our monthly email
newsletter distribution list.
New here? Sign up.
SIGN IN TO CUREUS
sign in using LinkedIn
sign in using Google
sign in using Facebook
--------------------------------------------------------------------------------
or
Sign in with your email address:
Email
Password
Don't have an account? Sign Up
Forgot your password?
Resend confirmation instructions
SIGN UP FOR CUREUS
sign up using LinkedIn
sign up using Google
sign up using Facebook
--------------------------------------------------------------------------------
or
First name
Last name
Email
Password
Specialty
Please choose I'm not a medical professional. Allergy and Immunology Anatomy
Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care
Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology
and Public Health Family Medicine Forensic Medicine Gastroenterology General
Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based
Medicine I'm not a medical professional. Infectious Disease
Integrative/Complementary Medicine Internal Medicine Internal
Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical
Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition
Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry
Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management
Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and
Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry
Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use
and Addiction Surgery Therapeutics Trauma Urology Miscellaneous
EMAIL COMMUNICATION AND PERSONAL DATA
Cureus personal data will never be sold to third parties and will only be used
to enrich the user experience and contact you in direct relation to the
application. I agree to opt in to this communication.
By joining Cureus, you agree to our Privacy Policy and Terms of Use.
ClapView clapsDownload PDFDownload citationShare via emailSelect sharing
optionShare on RedditShare on FacebookShare on TwitterPublished: June 10, 2022
(see history)
DOI: 10.7759/cureus.25809Copy to clipboardDownload PDFDownload citationShare via
emailSelect sharing optionShare on RedditShare on FacebookShare on Twitter