Cutaneous hemophagocytosis after alemtuzumab injection in a patient with Sézary syndrome.

Approximately20%ofpatientspresentwithatypicalorvariant formsof PR,which are less readily recognized than typical eruptions and may pose a diagnostic challenge.2,3 The morphologic characteristics of the eruption may be papular, vesicular, purpuric or hemorrhagic, or urticarial. Very small lesions will be observed in papular PR, and PR with enormous plaques is known as pityriasis rosea gigantea of Darier. Amorphologic variant characterized by atypical large patches that tend to be few in number and coalescent has been described. In this variant, commonly referred to as pityriasis circinata et marginataofVidalor limb-girdlePR, theeruptiongenerally appears in the axillae, the groin, or both, with the trunk and extremities usually spared.4,5 A simple classification for atypical pityriasis rosea has been proposed by Chuh and Zawar (Box).6 In our patient, the eruption fulfills all 3 essential clinical features (discrete annular lesions, scaling, andperipheral collarette scaling with central clearance on at least 2 lesions), all 3 optional clinical features (relative truncal distribution, orientationalongskincleavage lines, andheraldpatch), andnone of the exclusional clinical features. This case has clinical featuresof localizedPR,papularPR,andpityriasiscircinataetmarginata of Vidal. It should also be noted that the involvement of penile and scrotal skin is rarely reported in PR. Physicians should be aware of the wide spectrum of PR variants so that appropriate management and reassurance can be offered.