A case of rapidly progressive, ulcerating nodules and plaques

A 73-year-old Indian man with Fitzpatrick skin phototype V presented to the emergency department with a 1-month history of extensive, painful, rapidly progressive ulcerating nodules and plaques on the arms, trunk and thighs and features of leonine facies. The patient had previously been treated with two courses of oral antibiotics and oral corticosteroids in the community for presumed infected eczema. A skin biopsy sent for histopathology showed epidermotropism and sheets of atypical lymphoid infiltrate extending into the subcutis. The cells were positive for CD2, CD5, CD8, BF1, TIA and granzyme B. They were negative for CD4, CD7, CD30, CD56, delta and EBER. Ki-67 showed a proliferative index of almost 100%.