Mycosis fungoides masquerading as an ischemic foot

This case is of a man with bilateral lower-extremity ischemia and a solitar y nonhealing ulcerated lesion of the right great toe. After revascularizati on with an aortobifemoral bypass, his right ABI increased from 0.5 to appro ximately 0.75, but the ulcerated toe lesion did not show signs of healing a nd instead progressed to a deeper ulceration exposing bone. Because of pres umptive osteomyelitis, we performed a great toe amputation, and immunohisto chemical analysis of the lesion revealed late plaque stage mycosis fungoide s (MF). We present this case to alert the vascular surgeon to this diagnost ic possibility when confronted with an apparent ischemic lesion and to desc ribe what made this particular lesion suspicious for MF. To the best of our knowledge, this is the first case of MF presenting solely as an ischemic l esion.