Hurricane Katrina evacuee develops a persistent rash

Dx: T-cell lymphoma—timing is coincidental

The biopsy revealed cutaneous T-cell lymphoma (CTCL)—specifically a type known as mycosis fungoides, named after the mushroom-like skin tumors seen in severe cases. CTCL is a malignant lymphoma of helper T-cells that have an affinity for the skin.

Normal life expectancy likely if diagnosed early

In about 10% of cases, the T-cells spread via the lymphatic system to metastasize to the liver, lung, and bone marrow, but more often remain confined to the skin and lymph nodes, and most patients diagnosed early have a normal life expectancy.¹

The disease is rare, with about 1000 new cases per year in the US,¹ and is more common in African Americans,² although the photos in dermatological atlases overwhelmingly show Caucasians. CTCL presents in numerous ways, but patients usually have a long course of persistent rash that is often pruritic and usually erythematous or hyperpigmented.

No one knows what causes CTCL, but current theories point to exposure to environmental hazards such as Agent Orange.² And while the number of environmental hazards in the floodwaters of Katrina were vast, we have no scientific evidence that an environmental exposure was to blame. In fact, while we cared for a number of Katrina evacuees—many of whom had skin infections—this was the only case of mycosis fungoides.

It’s likely that the start of the visible mycosis fungoides lesions after the flood was purely coincidental.