Cutaneous T-cell lymphoma in a cardiac transplant recipient.
Mycosis fungoides, an uncommon form of cutaneous T-cell lymphoma, arises in the skin and frequently progresses to generalized lymphadenopathy Although the cause of cutaneous T-cell lymphoma is unknown, chronic immunosuppression may play a role. A few cases have been reported in renal transplant recipients; however, ours appears to be the 1st report of cutaneous T-cell lymphoma in a cardiac transplant recipient. In our patient, cutaneous manifestations of the disease were noted less than 1 year after transplantation. Seven years after transplantation, Sézary syndrome, a variant form of mycosis fungoides, was diagnosed by tissue biopsy and flow cytometry analysis. Photopheresis improved symptoms but was not well tolerated because of hemodynamic sequelae. Psoralen and ultraviolet A therapy also improved the patient's skin condition, but a generalized lymphadenopathy developed. The maintenance immunosuppressive regimen was changed from cyclosporine (3 mg/kg/day) and azathioprine to cyclosporine (1.5 mg/kg/day) and cyclophosphamide. Although effective in the short-term, the results of this therapeutic strategy could not be fully evaluated because the patient died of acute myocardial infarction.
McMullan
D M
DM
Texas Heart Institute and St Luke s Episcopal Hospital Houston, 77225-0345, USA.
Radovaneević
B
B
Jackow
C M
CM
Frazier
O H
OH
Duvic
M
M
D000368:Aged; D001379:Azathioprine / Q000009:adverse effects; D016572:Cyclosporine / Q000009:adverse effects; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D009182:Mycosis Fungoides / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D011701:PUVA Therapy; D017893:Photopheresis; D011241:Prednisone / Q000009:adverse effects; D012751:Sezary Syndrome / Q000453:epidemiology / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone