To our knowledge, the only context in which an immunotypic shift in CTCL has been seen concurrently with any sort of large cell transformation was described by Bitar et a., in which a 78-year-old male with MF showed a phenotypic shift from CD4+/CD8- to double-negative CD4-/CD8- with large cell transformation [10]. The gene discussed is CD4; the disease is mycosis fungoides.