A rare coexistence of mycosis fungoides and myelodysplastic neoplasm

Abstract

This case report details the presentation and management of a 71-year-old man with a known history of myelodysplastic neoplasm presenting with hypopigmented flat lesions on his chest, abdomen, and extremities over a three-month period, with mild scaling and severe pruritus and evaluated with a detailed dermatological examination and a multidisciplinary diagnostic approach. Laboratory findings showed anemia, leukopenia, and dysgranulopoiesis on peripheral smear. Chromosome analysis revealed an abnormal male complement with Y chromosome loss in 70% of cells. Bone marrow biopsy and aspiration cytology confirmed myelodysplastic syndrome (MDS) with ringed sideroblasts. Skin biopsy showed early-stage mycosis fungoides (MF), positive immunohistochemistry for CD3, CD5, CD8, and Ki-67 index over 70%. Treatment involved weekly blood transfusions, erythropoietin injections, and supportive management for MDS, while MF was managed with topical emollients, antihistamines, and psoralen ultraviolet A therapy. Monthly follow-up demonstrated symptomatic improvement of the skin condition but worsening of general status of the patient. The patient’s unique clinical course highlights the complexity of managing dual malignancies, requiring a tailored and multidisciplinary approach.