Race for the Case

Race for the Case is a clinical quiz feature published quarterly in Dermatology World Directions in Residency — and right here!

Review the case and photos, and submit your answers to the questions below. If you answer correctly, you'll be entered to win a $25 Starbucks gift card. Free coffee and pastries are on the line — what are you waiting for?


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A 78-year-old male presented to dermatology clinic with a 5-year history of an eruption that is pruritic and painful. He denied fevers, chills, night sweats, and weight loss. His past medical history is otherwise non-contributory. Prior skin biopsies showed psoriasiform dermatitis. He had been previously treated with methotrexate, oral prednisone, and various topical steroids with minimal improvement. On skin exam, he had ill-defined, pink, scaly patches on his chest, legs, and buttocks, several well-demarcated pink to violaceous patches and plaques on his arms and back, and tender nodules on bilateral arms. No lymphadenopathy was appreciated. Skin biopsy from the arm showed epidermotropic atypical lymphocytes in the epidermis along with a superficial and deep lymphocytic infiltrate in the dermis. CD3 highlighted the majority of the infiltrate, with a CD4:CD8 ratio of 6:1. PET/CT showed mild increased FDG activity in cutaneous lesions, but was otherwise unremarkable.

What is the diagnosis?
What does a comprehensive work-up of this condition typically consist of?
What is the typical immunophenotype?
What are the treatment options?
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