Co-Occurrence of Agminated Lentigines, Café-Au-Lait Macules, and Vitiligo: A Case Report and Literature Review.

Lentigines, café-au-lait macules (CALMs), and vitiligo are pigmentary disorders that seldom occur together in a single individual. Their co-occurrence may indicate underlying genetic syndromes requiring differential diagnosis. We report an 18-year-old male who developed CALMs at age 11, agminated lentigines at age 13, and vitiligo on the right chest six months thereafter. Comprehensive examinations excluded Peutz-Jeghers syndrome, Leopard syndrome, Carney complex, and Neurofibromatosis type 1. Eight-year follow-up-the longest reported for this combination-demonstrated a benign natural history: Stable vitiligo throughout and lentigines reaching a plateau by early adulthood. Negative autoimmune screening suggests localized immune dysregulation, supporting the Immunocompromised Cutaneous District hypothesis. A staged therapeutic approach prioritizing vitiligo stabilization is recommended.