Superinfected case of Mycosis fungoides with S.aureus

    A 54 year-old Caucasian man had a three-year history of pagetoid reticulosis MF variant with initial IIB stage. Tumor lesions achieved a complete response with radiation therapy while patches remained stable with topical bexarotene and topical steroids. His past medical history was consistent with Wegener’s granulomatosis that required kidney transplantation, papillary renal cell carcinoma of non-functional kidneys and monoclonal gammopathy of undetermined significance. In a follow up visit, patient complained of a growing over enlarged tumor lesion that appeared on his right lateral calf, and was associated with purulent drainage. Constitutional symptoms were not manifested. A biopsy and tissue culture were performed and 300 mg bid clindamycin were prescribed empirically. The biopsy showed an extensive dermal infiltrate with focal epidermotropism of large and pleomorphic lymphocytes (> 25%), with margination of neutrophils and granulation tissue. Tumoral cells were positive for CD3, and negative for CD4, CD8, CD30. Gram stain demonstrated many gram-positive cocci in colonies within the dermis. Other special stain failed to demonstrate fungal or mycobacterial organisms. LCT mycosis fungoides was diagnosed. S.aureus methicillin – sensible grew on the tissue culture. Treatment with 100 mg bid Doxycycline and chlorox baths were then prescribed with improvement of the tumoral lesion.  After radiation therapy (400cGy), tumor lesion regressed one month later.