A Case Report of Cutaneous T-Cell Lymphoma – A Swift Strike

The diagnosis of cutaneous T-cell lymphoma (CTCL) often poses a significant clinical challenge due to the marked variability and overlap of its clinicopathological features with a spectrum of benign dermatological conditions. Consequently, patients frequently experience symptoms mimicking common entities such as eczema, chronic spongiotic dermatitis, parapsoriasis and psoriasis for a considerable duration, often years, before a definitive diagnosis of CTCL is established. This diagnostic delay can lead to the disease progressing unnoticed until more advanced stages, potentially impacting treatment outcomes and causing frustration for clinicians. The mean time from the initial onset of symptoms to a confirmed diagnosis typically spans 3 to 4 years, but in some instances, it can extend to decades. This case report details the presentation of a 70-year-old male who exhibited a relatively rapid progression to Sézary syndrome (SS), the leukemic variant of CTCL. His initial symptoms of generalised pruritus and evolving scaly lesions rapidly progressed to involve the majority of his body surface area, accompanied by systemic features including significant weight loss and lymphadenopathy. Investigations revealed a high peripheral blood leukocyte count with circulating Sézary cells, and skin biopsy findings consistent with CTCL. Immunohistochemistry showed a characteristic T-helper cell phenotype (CD3+, CD4+ and CD7-). Bone marrow involvement confirmed the diagnosis of SS. This case underscores the importance of considering CTCL in the differential diagnosis of persistent and treatment-refractory generalised dermatoses, even when the initial presentation might seem benign, particularly when systemic symptoms and lymphadenopathy are present. The swift progression observed in this case highlights the aggressive potential of certain CTCL variants and the need for timely and comprehensive diagnostic evaluation to facilitate prompt management.