Photosensitive presentation of aggressive mycosis fungoides mimicking systemic lupus erythematosus

A 62-year-old female with a history of carcinoma cervix presented with fever, oral erosions, joint pains, and photosensitivity of 6 months duration. On examination, the patient had multiple discrete erythematous macules, papules, and plaques on the face and forearms in a photo distribution. The patient was investigated on the lines of systemic lupus erythematosus, but the antinuclear antibody profile was negative. Slit skin smear from skin lesions showed malignant lymphocytes. Peripheral smear and bone marrow smear showed malignant lymphocytes. Skin biopsy showed the entire dermis packed with malignant lymphocytes. Immunocytochemistry showed malignant lymphocytes which are CD3+, CD4+, CD30 negative, CD20 and CD117 negative, diagnostic of mycosis fungoides (MF). The patient expired before the treatment could be started. We are reporting an aggressive form of MF presenting with the clinical features suggestive of systemic lupus erythematosus.