Mycosis fungoides is a rare, slowly evolving lymphoproliferative neoplasm and a variant of cutaneous T-cell non-Hodgkin lymphoma that can present with medullary infiltration in advanced stages. Treating this condition is challenging, especially in patients with comorbidities who do not respond well to conventional therapies. Photopheresis therapy has emerged as an effective, well-tolerated, and immunomodulatory approach that is particularly useful in refractory cases.

We present the case of a 62-year-old obese, diabetic, and dyslipidemic white female patient with a history of reduced mobility due to plantar hyperkeratosis with fissures and pain upon walking, as well as significant tooth loss, which led to low self-esteem, physical weakness, and emotional distress. Her condition began in 2007 with an initial diagnosis of generalized atopic dermatitis. She was treated with corticosteroids for nine years. Following several biopsies and a myelogram, cutaneous T-cell non- Hodgkin lymphoma/mycosis fungoides with medullary infiltration (Sézary syndrome) was confirmed. The patient was initially treated with interferon-alpha, but treatment was discontinued due to its unavailability. She then received chemotherapy using the CHOP protocol. In May 2022, she began weekly photopheresis therapy, totaling 48 sessions per year, in conjunction with brentuximab vedotin administered every 21 days for 16 cycles. After three months of treatment, significant improvements in symptoms were observed, including regression of pruritus, reduction of skin desquamation, improvement of atopic dermatitis, relief of plantar fissures and pain while walking, recovery of self-esteem, and improvement of physical and emotional weakness. Treatment was temporarily interrupted between October and November 2023 due to prolonged clinical hospitalization related to a Permcath catheter infection and congestive heart failure. Treatment resumed with a positive response and no serious complications.

The presented clinical experience demonstrates the efficacy and safety of photopheresis therapy in treating advanced mycosis fungoides with spinal cord infiltration, particularly in patients with multiple comorbidities who have not responded to previous therapies. The significant improvement in cutaneous and systemic symptoms and quality of life reinforces the importance of an individualized therapeutic approach in specialized centers and contributes to advancing clinical practices in cutaneous lymphomas.