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Old 10-01-2011
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Skin dermal infiltrates of atypical CD4+ T cells with cerebriform nuclei

A 49 years old man was admitted to the hospital because of itchy reddish patches all over the body since childhood, ulcers on left foot since 22 months, and an ulcer over the sternum since 15 months. He was given steroids for 6 weeks, considering the diagnosis of immune allergy dermatitis, which was not beneficial. In physical examination his whole skin was covered with erythematous plaques with fine scales and pruritus was present. The following photo was taken from his knee:

dermal infiltrates of atypical CD4+ T cells with cerebriform nuclei-skin-rash.jpg
click image to enlarge

Lab data revealed ESR of 88, normal peripheral blood smear, Negative VDRL, and negative Anti dsDNA. The ulcer over the sternum measured 5 * 3 cm with necrotic base with areas of granulation tissues, the margins were irregular. Biopsy from the ulcer revealed dermal infiltrates of atypical CD4+ T cells with cerebriform nuclei. What is the most likely diagnosis?

A) Malignant melanoma
B) Bullous pemphigoid
C) Basal cell carcinoma
D) Mycosis fungoides
E) Pemphigus vulgaris
F) Wiskott-Aldrich syndrome
G) Job's syndrome
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Old 10-02-2011
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I think it is d) Mycosis fungoides.

Note: its difficult to visualize the lesion with such a big Image :P
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Old 10-02-2011
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D mycosis Fungiodes
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Old 10-02-2011
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Mycosis fungoides most likely

btw can i ask you the source of these questions
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Old 10-03-2011
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Correct Answer Answer

Quote:
Originally Posted by usmle2011 View Post
Mycosis fungoides most likely

btw can i ask you the source of these questions

I made this question by myself based on a real case of mycosis fungoides (see the link below). It was really helpful for me to remember the disease.

http://zuberi.net/published/PMJ-X-18.pdf

Hope this question provide you with standard information regarding this disease.
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Old 10-03-2011
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D) Mycosis fungoides
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