Granulomatous slack skin: a case report demonstrating the evolution of the 16-year clinicopathological features that confuses with leprosy at its early stage

Walaiorn Pratchyapruit; Niramol Vashrangsi; Hachiro Tagami

Authors

Walaiorn Pratchyapruit INSTITUTE OF DERMATOLOGY, BANGKOK, THAILAND
Niramol Vashrangsi INSTITUTE OF DERMATOLOGY, BANGKOK, THAILAND
Hachiro Tagami EMERITUS PROFESSOR OF DERMATOLOGY, DERMATOLOGIC DEPARTMENT, TOHOKU UNIVERSITY SCHOOL OF MEDICINE, SENDAI CITY, MIYAGI PREFECTURE, JAPAN

Keywords:

granulomatous slack skin, leprosy, mycosis fungoides, chemotherapy

Abstract

A middle-aged Thai male suffered from granulomatous slack skin (GSS), a rare subtype of mycosis fungoides (MF), whose benign clinical course was exemplified by an exceedingly long evolution of skin lesions taking over 16 years. His clinical course and histopathological features demonstrated the gradual changes from an early nonspecific skin lesion to a typical lesion of GSS, eventually leading to GSS concurrent with MF. At the initial stage, there were tuberculous granulomatous features suggestive of borderline leprosy despite its atypical clinical manifestation. In contrast, the latest ones showed unique granulomatous changes associated with scattered large foreign body giant cells showing phagocytosis of lymphocytes and fragmented elastic fibers, and lymphocytic epidermotropism with the formation of a Pautrier’s microabscesses in the overlying epidermis. During these changes of his clinical course from initial non-specific lesion to the latest MF stage IA (T1 N0 M0 B0) and then stage II B (T3 N0 M0 B0), his skin lesions partially responded to WHO anti-leprosy regimen and several courses of chemotherapy i.e. a combination of COP and MTX, and CHOP regimen.

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