Lymphomatoid papulosis associated with recurrent cutaneous T-cell lymphoma.

INTRODUCTION Lymphomatoid papulosis is a chronic benign disease which may be associated with malignant lymphomas. This case illustrates the relapsing and remitting nature of both lymphomatoid papulosis and its potential of developing cutaneous T-cell lymphoma and narrow-band ultraviolet B (NB-UVB) phototherapy as a new modality of treatment of early-stage mycosis fungoides in these patients. CLINICAL PICTURE A 44-year-old woman has had recurrent crops of papules and nodules of lymphomatoid papulosis on the limbs for 15 years. Histological features are consistent with the type B lesions of lymphomatoid papulosis. Eight years after the initial onset of these lesions she developed cutaneous T-cell lymphoma (mycosis fungoides). Since then, she has had recurrence of mycosis fungoides following the cessation of phototherapy, but had no evidence of systemic involvement. TREATMENT The lesions of lymphomatoid papulosis responded to intermittent courses of oral methotrexate. Mycosis fungoides was treated with oral psoralen and ultraviolet A phototherapy with good response. Unfortunately, the lesions relapsed, whenever phototherapy was discontinued. The most recent recurrence of mycosis fungoides was treated with NB-UVB therapy. OUTCOME The papules of lymphomatoid papulosis continue to appear but she remains free of lesions of mycosis fungoides, 10 months after cessation of NB-UVB therapy. CONCLUSION Long-term surveillance is essential in all cases of lymphomatoid papulosis as accurate predictors for the development of malignant lymphoma in these individuals are still lacking.