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A case of pigmented purpuric eruptions evolving to mycosis fungoides during the 4-year follow-up period is described. Clinical manifestation was characterized by petechial lesions with irregular shaped, diffusely pigmented plaques partly sharing morphological similarities with chronic pigmented purpura. Histologically, lymphocytes infiltrated around the capillaries of the superficial dermis with extravasated erythrocytes as well as into the epidermis to form Pautrier microabscesses. Whereas CD4+ cells were observed in the epidermis and upper dermis, CD8+ cells tended to be distributed around the capillaries. Notably, the Rumpel-Leede test revealed extensive punctuate purpura limited to the lesional skin. The aggregation response of platelets was not impaired. Either CD4+ tumor lymphocytes or CD8+ reactive lymphocytes appeared to induce capillary damage resulting in the formation of petechial lesions. Pigmented purpuric eruptions, such as atypical chronic pigmented purpura, is thus an important initial clinical manifestation of mycosis fungoides.

A 62-year-old man with amyloid deposition associated with generalized morphea-like scleroderma is described. He had been occupationally exposed to organic solvents. Physical examination showed sclerosis of fingers, forearms, and trunk. Erythema was noted on the border of patchy sclerotic plaques on his chest and back. In addition, firm miliary, keratotic papules were found on the lateral forearms. Amyloid deposition was demonstrated by Congo-red stain at papillary layers of overlying sclerotic dermis in the biopsied specimen taken from the left forearm. As far as we know, amyloid deposition associated with generalized morphea-like scleroderma has not been reported until now.