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Concentric Annular Truncal Eruption

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A man in his 60s presented to the dermatology clinic with a widespread, intermittently pruritic eruption. Examination showed coalescing annular, arcuate, and serpiginous red scaling plaques in a concentric pattern diffusely involving the chest, back, and abdomen with extension to proximal extremities (Figure, A and B). Punch biopsies from the chest (Figure, C and D) and back were obtained for histopathology and tissue culture. Treatment with topical corticosteroids under wet dressings was associated with partial improvement in the eruption and pruritus.

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B. Erythema gyratum repens–like eruption associated with mycosis fungoides

Punch biopsies showed an epidermotropic infiltrate of small to medium atypical lymphocytes focally distributed along the dermal-epidermal junction and forming Pautrier microabscesses (Figure, C). Admixed in the infiltrate were large atypical cells, which comprised 25% to 50% of the lymphocytes depending on biopsy site. The atypical lymphocytes expressed CD2, CD3, CD4 (partial), CD30 (partial; Figure, D), and TCRαβ, and exhibited complete loss of CD7 as well as partial loss of CD5 expression. Periodic acid–Schiff stain and tissue culture were negative for fungus. Histopathologic and immunophenotypic features were consistent with mycosis fungoides (MF) with large cell transformation.

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Article Information

Corresponding Author: Nneka I. Comfere, MD, Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (comfere.nneka@mayo.edu).

Published Online: August 19, 2020. doi:10.1001/jamadermatol.2020.2779

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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