Mycosis fungoides presenting with pigmented purpuric rash

A 55-year-old woman presented with a pruritic rash existing for three months which was unresponsive to topical steroids. Dermatologic examination revealed generalized purpuric patches with unclear borders primarily localized on buttocks, abdomen, wrists and upper legs. Biopsy taken with diagnoses of pigmented purpuric dermatosis, pityriasis Rosea and mycosis fungoides, showed superficial and middermal lymphoid infiltrate with epidermotrophism and atypical large cerebriform cells as well as basaloid vacuolization, spongiosis and extravasated erythrocytes in the superficial dermis.