RESUMO
COVID-19 infection and vaccination may be associated with a wide variety of cutaneous and immune manifestations. Here, we describe two patients who presented with monoclonal cutaneous T-cell infiltrates that showed cytologic and immunophenotypic features concerning for lymphoma shortly following COVID-19 vaccination. In one case, the eruption completely resolved. The second patient showed initial resolution, but her disease recurred and progressed following a breakthrough SARS-CoV-2 infection. These cases suggest that immune stimulation following exposure to SARS-Cov-2 protein(s) in vaccine or infection may facilitate the development of a lymphoma or lymphoproliferative disorder in susceptible individuals. Moreover, they show that separating these cases from pseudolymphomatous reactive conditions is often challenging and requires close clinical correlation.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Linfoma , Papulose Linfomatoide , Neoplasias Cutâneas , Feminino , Humanos , Vacinas contra COVID-19/efeitos adversos , Exantema , Linfoma/induzido quimicamente , Linfoma/patologia , Papulose Linfomatoide/induzido quimicamente , Papulose Linfomatoide/patologia , Recidiva Local de Neoplasia , SARS-CoV-2 , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/patologia , Vacinação/efeitos adversos , Infecções IrruptivasRESUMO
ABSTRACT: Janus kinase (JAK) inhibitors are being prescribed with increasing regularity in dermatology. We report on a patient who initiated treatment with tofacitinib for refractory erythema elevatum diutinum and subsequently developed a novel cutaneous outbreak characterized by firm violaceous papules on the trunk and extremities along with conjunctival injection and periorbital inflammation. Biopsy of affected tissue from both the cutaneous and ophthalmologic sources demonstrated increased numbers of CD30+ large atypical cells amid a mixed inflammatory cell infiltrate, consistent with lymphomatoid papulosis. A review of the literature reveals a plausible mechanism for the induction of persistent JAK signaling in the presence of a JAK inhibitor. We discuss this mechanism in depth because it pertains to this patient and recommend continued vigilance with the use of these immunologic agents.
Assuntos
Papulose Linfomatoide , Vasculite Leucocitoclástica Cutânea , Humanos , Antígeno Ki-1 , Papulose Linfomatoide/induzido quimicamente , Papulose Linfomatoide/tratamento farmacológico , Piperidinas/efeitos adversos , PirimidinasRESUMO
Lymphomatoid papulosis (LyP) is a paraneoplastic primary cutaneous CD30+ lymphoproliferative disorder (LPD) that has been associated with malignant lymphomas, most commonly mycosis fungoides (MF). We observed 10 patients with MF who developed severe inflammation after using nitrogen-mustard (NM) gel from 1 to 8 months and who developed LyP. We hypothesized that NM gel produced local inflammation, which induced CD30 expression in malignant T cells in situ leading to the appearance of LyP papules. The high frequency of induction of LyP lesions in patients with severe inflammation while on treatment with NM gel suggests an association between inflammatory stimuli and development of LyP. Our observation provides insight into the pathogenesis of CD30+ LPD.
Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Papulose Linfomatoide/imunologia , Mecloretamina/efeitos adversos , Micose Fungoide/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Adulto , Idoso , Antineoplásicos Alquilantes/administração & dosagem , Feminino , Géis , Humanos , Antígeno Ki-1/imunologia , Antígeno Ki-1/metabolismo , Papulose Linfomatoide/induzido quimicamente , Papulose Linfomatoide/patologia , Masculino , Mecloretamina/administração & dosagem , Pessoa de Meia-Idade , Pele/efeitos dos fármacos , Pele/imunologia , Pele/patologia , Adulto JovemAssuntos
Cloridrato de Fingolimode/efeitos adversos , Papulose Linfomatoide/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Cloridrato de Fingolimode/uso terapêutico , Humanos , Papulose Linfomatoide/diagnóstico , Esclerose Múltipla/tratamento farmacológico , Neoplasias Cutâneas/diagnósticoRESUMO
BACKGROUND: Fingolimod was the first oral disease-modifying treatment for relapsing-remitting multiple sclerosis. It has previously been associated with the development of lymphoma. OBJECTIVE: To describe a case of lymphomatoid papulosis, a CD30+ cutaneous lymphoproliferative disorder, in a patient taking fingolimod. METHODS: Case study. RESULTS: Our patient developed lymphomatoid papulosis 2 months after starting fingolimod. Histology confirmed the diagnosis. The drug was withdrawn. Resolution began only 2 days later. CONCLUSIONS: Lymphomatoid papulosis is a benign subtype of cutaneous T-cell lymphoma, but up to 20% of cases can transform to a malignant course. Patients on fingolimod and physicians caring for them should be mindful of the need to monitor the skin.
Assuntos
Cloridrato de Fingolimode/efeitos adversos , Imunossupressores/efeitos adversos , Papulose Linfomatoide/induzido quimicamente , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Neoplasias Cutâneas/induzido quimicamente , Adulto , Feminino , HumanosAssuntos
Linfoma Anaplásico de Células Grandes/induzido quimicamente , Papulose Linfomatoide/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Tatuagem/efeitos adversos , Corantes/efeitos adversos , Toxidermias/etiologia , Feminino , Humanos , Compostos de Mercúrio/efeitos adversos , Pseudolinfoma/diagnóstico , Dermatopatias/diagnóstico , Adulto JovemRESUMO
We report two cases of lymphomatoid papulosis (LyP) occurring in conjunction with B-cell lymphoproliferative malignancies where the LyP was exacerbated during rituximab (anti-CD20 antibody)-based therapy. We postulate that the altered B-cell cytokine milieu acted to allow an exacerbation of the patient's concomitant T-cell disease and discuss the possible mechanisms by which this may have occurred.
Assuntos
Anticorpos Monoclonais Murinos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Progressão da Doença , Fatores Imunológicos/efeitos adversos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Linfoma Folicular/tratamento farmacológico , Papulose Linfomatoide/imunologia , Idoso , Anticorpos Monoclonais Murinos/administração & dosagem , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , Fatores Imunológicos/administração & dosagem , Leucemia Linfocítica Crônica de Células B/complicações , Linfoma Folicular/complicações , Papulose Linfomatoide/induzido quimicamente , Papulose Linfomatoide/complicações , Masculino , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Rituximab , Vidarabina/administração & dosagem , Vidarabina/análogos & derivados , Vincristina/administração & dosagemRESUMO
Anti-tumor necrosis factor (TNF) agents are now well regarded as highly effective treatment modalities for multiple immunologically mediated diseases, including rheumatoid arthritis, Crohn's disease and psoriasis. The mechanism of action for this particular class of medications involves the blockade of multiple intracellular signaling pathways originating from TNF-α, ultimately inducing a generalized immunosuppressed state. In fact, several cases of lymphomas have been reported in patients treated with anti-TNF-α agents, though it has been difficult to prove any degree of causality. Herein, we described a patient who developed lymphomatoid papulosis after being treated with adalimumab, whereby a clear causality could be established.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Juvenil/tratamento farmacológico , Papulose Linfomatoide/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Adalimumab , Adulto , Humanos , Masculino , Fator de Necrose Tumoral alfa/antagonistas & inibidoresAssuntos
Ciclosporina/administração & dosagem , Imunossupressores/administração & dosagem , Papulose Linfomatoide/induzido quimicamente , Pioderma Gangrenoso , Neoplasias Cutâneas/induzido quimicamente , Clobetasol/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Papulose Linfomatoide/patologia , Pessoa de Meia-Idade , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/patologiaAssuntos
Anticorpos Monoclonais/efeitos adversos , Toxidermias/patologia , Imunossupressores/efeitos adversos , Papulose Linfomatoide/induzido quimicamente , Papulose Linfomatoide/patologia , Psoríase/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We report a 36-year-old man with atopic eczema who developed lymphomatoid papulosis while taking ciclosporin. Latent membrane protein 1 and in situ hybridization for Epstein-Barr virus were negative. There are only two reports in the literature of patients taking ciclosporin to control atopic eczema who developed primary cutaneous CD30+ T-cell lymphoproliferative disorders. The development of T-cell lymphoproliferative disorders including lymphomas is well described in patients with solid organ transplants who are taking ciclosporin. Also, it has been noted in patients taking ciclosporin for rheumatological conditions or psoriasis.