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Journal of the American Academy of Dermatology
Volume 47, n° 2PB
pages 168-171 (août 2002)
Doi : 10.1067/mjd.2002.107231
Invisible mycosis fungoides: A diagnostic challenge

Ramon M. Pujol, MDa, Fernando Gallardo, MDb, Enric Llistosella, MDc, Aurora Blanco, MDd, Lluı́s Bernadó, c, Ramon Bordes, MDe, Josep F. Nomdedeu, MDf, Octavio Servitje, MDb
From the Departments of Dermatology,a Pathology,e and Hematology,f Hospital de la Santa Creu i Sant Pau, Barcelona; Hospital Princeps d'Espanya,b Barcelona; Hospital Josep Trueta,c Girona; and Institut de Reçerca Oncologica,d Barcelona. 


We describe a 76-year-old woman who had persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsy specimens obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J8 V2 C2 TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed. (J Am Acad Dermatol 2002;47:S168-71.)

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