ABSTRACT
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.
Subject(s)
COVID-19 Vaccines , COVID-19 , Lymphoma , Lymphomatoid Papulosis , Skin Neoplasms , Female , Humans , COVID-19 Vaccines/adverse effects , Exanthema , Lymphoma/chemically induced , Lymphoma/pathology , Lymphomatoid Papulosis/chemically induced , Lymphomatoid Papulosis/pathology , Neoplasm Recurrence, Local , SARS-CoV-2 , Skin Neoplasms/chemically induced , Skin Neoplasms/pathology , Vaccination/adverse effects , Breakthrough InfectionsABSTRACT
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.
Subject(s)
Lymphomatoid Papulosis , Vasculitis, Leukocytoclastic, Cutaneous , Humans , Ki-1 Antigen , Lymphomatoid Papulosis/chemically induced , Lymphomatoid Papulosis/drug therapy , Piperidines/adverse effects , PyrimidinesABSTRACT
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.
Subject(s)
Fingolimod Hydrochloride/adverse effects , Immunosuppressive Agents/adverse effects , Lymphomatoid Papulosis/chemically induced , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Skin Neoplasms/chemically induced , Adult , Female , HumansABSTRACT
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.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Disease Progression , Immunologic Factors/adverse effects , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Lymphoma, Follicular/drug therapy , Lymphomatoid Papulosis/immunology , Aged , Antibodies, Monoclonal, Murine-Derived/administration & dosage , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Humans , Immunologic Factors/administration & dosage , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Lymphoma, Follicular/complications , Lymphomatoid Papulosis/chemically induced , Lymphomatoid Papulosis/complications , Male , Middle Aged , Prednisolone/administration & dosage , Rituximab , Vidarabine/administration & dosage , Vidarabine/analogs & derivatives , Vincristine/administration & dosageABSTRACT
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.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/adverse effects , Arthritis, Juvenile/drug therapy , Lymphomatoid Papulosis/chemically induced , Skin Neoplasms/chemically induced , Adalimumab , Adult , Humans , Male , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
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.
Subject(s)
Antineoplastic Agents, Alkylating/adverse effects , Lymphomatoid Papulosis/immunology , Mechlorethamine/adverse effects , Mycosis Fungoides/drug therapy , Skin Neoplasms/drug therapy , Administration, Cutaneous , Adult , Aged , Antineoplastic Agents, Alkylating/administration & dosage , Female , Gels , Humans , Ki-1 Antigen/immunology , Ki-1 Antigen/metabolism , Lymphomatoid Papulosis/chemically induced , Lymphomatoid Papulosis/pathology , Male , Mechlorethamine/administration & dosage , Middle Aged , Skin/drug effects , Skin/immunology , Skin/pathology , Young AdultSubject(s)
Lymphoma, Large-Cell, Anaplastic/chemically induced , Lymphomatoid Papulosis/chemically induced , Skin Neoplasms/chemically induced , Tattooing/adverse effects , Coloring Agents/adverse effects , Drug Eruptions/etiology , Female , Humans , Mercury Compounds/adverse effects , Pseudolymphoma/diagnosis , Skin Diseases/diagnosis , Young AdultSubject(s)
Cyclosporine/administration & dosage , Immunosuppressive Agents/administration & dosage , Lymphomatoid Papulosis/chemically induced , Pyoderma Gangrenosum , Skin Neoplasms/chemically induced , Clobetasol/administration & dosage , Female , Glucocorticoids/administration & dosage , Humans , Lymphomatoid Papulosis/pathology , Middle Aged , Pyoderma Gangrenosum/drug therapy , Pyoderma Gangrenosum/pathologyABSTRACT
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.