Cutaneous T‐cell Lymphoma of 12 Years Duration Initially Presenting in a Two Year Old

A 14‐year‐old Caucasian girl presented with an eczematous patch on the left proximal inner arm of 12 years duration. She had previously been treated with emollients and topical steroids without complete resolution. The patient denied constitutional symptoms but did note eczematous patches on her buttocks of one‐year duration and new eczematous patches on her inner left thigh and right inner upper arm. Upon exam, all lesions were slightly scaly without induration. The primary lesion was a poikilodermatous 4 × 10 cm rough plaque. No lymphadenopathy was noted. A total of five lesional biopsies were obtained. All of the biopsies demonstrated a superficial infiltrate of atypical lymphocytes with cerebriform nuclei and prominent epidermotropism including the formation of Pautrier’s microabcesses. The diagnosis of mycosis fungoides was rendered. This case is significant for its onset at two years of age, the benignity of its course over a 12 year period and the long duration before definitive diagnosis was obtained. Mycosis fungoides needs to be considered in the differential diagnosis of recalcitrant eczematous disease even in young children.