Association of erythrodermic cutaneous T-cell lymphoma, superantigen-positive Staphylococcus aureus, and oligoclonal T-cell receptor V beta gene expansion.
Forty-two patients with cutaneous T-cell lymphoma, including 31 with exfoliative erythroderma or Sezary syndrome and 11 with mycosis fungoides, were studied for the occurrence of staphylococcal infection. Thirty-two of 42 (76%) had a positive staphylococcal culture from skin or blood. One half of the patients with positive cultures grew Staphylococcus aureus. This group included 11 with Sezary syndrome and 5 with rapidly enlarging mycosis fungoides plaques or tumors. All of the S aureus carried enterotoxin genes. Surprisingly, 6 of 16 strains were the same toxic shock toxin-1 (TSST-1)-positive clone, designated electrophoretic type (ET)-41. Analysis of the T-cell receptor V beta repertoire in 14 CTCL patients found that only 4 had the expected monoclonal expansion of a specific V beta gene, whereas 10 had oligoclonal or polyclonal expansion of several V beta families. All patients with TSST-1+ S aureus had overexpansion of V beta Z in blood and/or skin lesions. These studies show that S aureus containing superantigen enterotoxins are commonly found in patients with CTCL especially individuals with erythroderma where they could exacerbate and/or perpetuate stimulate chronic T-cell expansion and cutaneous inflammation. Attention to toxigenic S aureus in CTCL patients would be expected to improve the quality of care and outcome of this patient population.
Jackow
C M
CM
Department of Dermatology, University of Texas Medical School, Houston, USA.
Cather
J C
JC
Hearne
V
V
Asano
A T
AT
Musser
J M
JM
Duvic
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000276:immunology*; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D001427:Bacterial Toxins; D015897:Comorbidity; D003873:Dermatitis, Exfoliative / Q000209:etiology* / Q000276:immunology; D004768:Enterotoxins / Q000276:immunology*; D005260:Female; D006801:Humans; D008213:Lymphocyte Activation; D016410:Lymphoma, T-Cell, Cutaneous / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000235:genetics / Q000276:immunology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D013207:Staphylococcal Skin Infections / Q000150:complications / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000276:immunology; D018089:Superantigens / Q000276:immunology*; D016176:T-Lymphocyte Subsets / Q000276:immunology* / Q000473:pathology
D000942:Antigens, Bacterial; D001427:Bacterial Toxins; D004768:Enterotoxins; D016693:Receptors, Antigen, T-Cell, alpha-beta; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal