Introduction: Plexiform neurofibromas (PNFs) represent benign neoplasms associated with neurofibromatosis type 1 (NF1), a genetic disorder characterized by mutations in the NF1 gene that lead to dysregulated Ras signaling and uncontrolled cell growth. NF1 manifests with various cutaneous features, including café-au-lait macules and axillary freckling, as well as the development of neurofibromas. PNFs are particularly complex due to their extensive involvement of nerve plexuses and their potential for malignant transformation. Case presentation: This case report documents a 42-year-old male who presented with numerous neurofibromas, café-au-lait macules, and axillary freckling. Notably, the patient had a large PNF on the right lower back, measuring 10x15 cm, which exhibited a “bag of worms” sensation upon palpation.figure1 Remarkably, this PNF contained multiple large comedones, each approximately 0.5x0.5 cm. Given the characteristic clinical presentation, a biopsy was deemed unnecessary to avoid unnecessary pain and potential complications associated with wound healing, as PNFs are known to be tender to touch. Conclusion: This case highlights an unusual presentation of PNF with large comedones, a manifestation not previously reported in the literature. The presence of comedones within a PNF emphasizes the need for thorough clinical evaluation and awareness of atypical manifestations in NF1 patients. This report contributes to the existing knowledge and underscores the importance of recognizing rare dermatological presentations to prevent misdiagnosis and ensure appropriate management.
Alhawsawi et al. (Wed,) studied this question.