RESUMO
BACKGROUND: The development of lupus erythematosus-like (LE-like) features in patients with cutaneous T-cell lymphoma (CTCL) has not been reported previously in the literature. Both diseases, however, have been etiologically linked to retroviruses. OBJECTIVE: Our purpose was to report four cases of patients with CTCL who developed LE-like features during the course of their disease, and to evaluate for evidence of antibodies to retroviruses in the sera of these patients. PATIENTS: Four patients with biopsy-proven CTCL with clinical or histologic features of systemic lupus erythematosus (SLE) were evaluated for clinical and laboratory criteria for SLE. Only one patient demonstrated four American Rheumatism Association (ARA) criteria sufficient for the diagnosis of SLE. The remaining three patients demonstrated one or two criteria for SLE. In addition, the sera of these patients were examined by Western blot analysis for evidence of human immunodeficiency virus type I (HIV-I), human T-cell lymphotrophic virus type I (HTLV-I), or human intracisternal A-type particle type I (HIAP-I) retroviral proteins. Each patient demonstrated antibodies to some of the retroviral proteins examined. The sera of two patients reacted to proteins for HIAP-I, and the sera of two patients reacted to p24 gag proteins of HIV-I. No patient reacted to HTLV-I proteins. CONCLUSIONS: Our report identifies four patients with CTCL who developed LE-like features during the course of their disease. Although the etiology of CTCL and SLE has not been well established, each has been linked to retroviruses. Evidence of antibodies to retroviral proteins was identified in each of our patients by Western blot analysis. Although the clinical and laboratory findings in these cases do not resolve the etiologic role of retroviruses in CTCL or SLE, they suggest that retroviruses may have a role in the pathogenesis of the clinical phenomenon reported in these four patients.
Assuntos
Lúpus Eritematoso Cutâneo/complicações , Linfoma Cutâneo de Células T/complicações , Idoso , Western Blotting , Feminino , Técnica Direta de Fluorescência para Anticorpo , Anticorpos Anti-HIV/análise , Infecções por HIV/complicações , Infecções por HIV/virologia , HIV-1/imunologia , Anticorpos Anti-HTLV-I/análise , Infecções por HTLV-I/complicações , Infecções por HTLV-I/virologia , Humanos , Lúpus Eritematoso Cutâneo/patologia , Lúpus Eritematoso Cutâneo/virologia , Linfoma Cutâneo de Células T/patologia , Linfoma Cutâneo de Células T/virologia , Masculino , Pessoa de Meia-Idade , Proteínas/análise , Pele/patologia , Proteínas Inibidoras de Apoptose Ligadas ao Cromossomo XRESUMO
The diagnosis of cutaneous T-cell lymphoma in patients under 20 years of age is extremely rare. We report five patients diagnosed before 20 years of age who illustrate the striking variations in clinical and histologic features as well as disease progression. We feel this information stresses the importance of multiple biopsies in young patients with chronic dermatoses.
