Mycosis fungoides in critically Ill cancer patients

Abstract

Mycosis fungoides is a rare disease that is part of a larger group of conditions known as cutaneous T-cell lymphomas and is likely caused by genetic and epigenetic changes in the DNA of affected individuals. For the critical care team, diagnosis of this condition can be confusing as mycosis fungoides-related skin lesions can appear very similar to other dermatologic conditions. The International Society of Cutaneous Lymphoma and the European Organization of Research and Treatment of Cancer have devised a diagnostic algorithm based on clinical, histopathologic, molecular biological, and immunopathogenic criteria. Staging is based on the extent of skin, lymph node, visceral organ, and blood involvement, with higher stage portending a worse prognosis. Patients with higher stage disease have low chance at cure, and these patients find themselves cycling through multiple lines of therapy with limited long-term efficacies. Such therapies include nonpharmacologic agents, such as UV light phototherapy or electron beam therapy, as well as pharmacologic agents, including topical and systemic agents such as steroids, retinoids, chemotherapy, imiquimod, methotrexate, histone deacetylase inhibitors, interferon, brentuximab vendotin, and denileukin diftitox. While the acute treatment of mycosis fungoides lies outside the realm of the intensive care unit, important issues facing the critical care team include disease manifestations and the potential side effects and complications of treatment including the risk of infections.