An Unusual Case of Mycosis Fungoides Presenting with Multiple Atypical Morphologies in a Photoexacerbated Distribution

This case study describes an unusual presentation of mycosis fungoides (MF) in an elderly male, characterized by multiple atypical morphologies and a photoexacerbated distribution. The patient exhibited pruritic erythematous lesions covering 70% of the body, with significant facial involvement and hair loss in affected areas. Initial misdiagnosis as leprosy delayed appropriate treatment. Histopathological analysis revealed atypical lymphocytic infiltrates with both CD4 and CD8 positivity, a rare finding in MF. Treatment with methotrexate, PUVA-Sol therapy, and topical corticosteroids initially improved the condition, but photoaggravation led to adjustments in therapy. The case highlights the diagnostic challenges posed by MF's varied presentations and the significance of the CD4+/CD8+ phenotype, which may indicate a lower risk of progression.