Mycosis Fungoides with Elevated WBC: A Rare Cutaneous T-Cell Lymphoma Variant
Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. “High white blood count” suggests Sézary syndrome (leukemic variant) or advanced MF with blood involvement.
Clinical Stages
- Patch/plaque stage: Scaly, itchy patches; years duration.
- Tumor stage: Nodules, ulceration.
- Erythroderma (Sézary): Total body redness, lymphadenopathy, circulating Sézary cells (>1000/µL).
Diagnosis
- Skin biopsy (histology, TCR gene rearrangement)
- Blood flow cytometry (Sézary cells)
- Lymph node biopsy if enlarged
Treatment
- Early: Topical steroids, retinoids, phototherapy (UVB, PUVA)
- Advanced: Systemic retinoids, interferon, HDAC inhibitors, brentuximab vedotin, chemo, extracorporeal photopheresis
Prognosis
Early stage: near-normal life expectancy. Advanced: variable; newer therapies improving outcomes.
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