Transient CD30+ nodal transformation of cutaneous T-cell lymphoma associated with cyclosporine treatment.
BACKGROUND
Mycosis fungoides (MF) may evolve from pre-existing chronic atopic or psoriasiform dermatitis and the histology can be equivocal. Early patch and plaque lesions of MF may evolve into tumors, disseminate to lymph nodes, bone marrow, and internal organs, and/or undergo transformation to a large cell size.


METHODS
A patient with a history of "atopic dermatitis" followed by "psoriasis" rapidly developed exfoliative erythroderma and axillary lymphadenopathy following treatment with cyclosporine. At presentation, biopsy specimens of skin lesions and lymph nodes and staging were obtained. We present the treatment and follow-up of this patient and review the medical literature for similar cases.


RESULTS
Multiple skin biopsy specimens from lesions revealed changes consistent with low-grade, cutaneous, T-cell lymphoma (MF) without evidence of large cell transformation and psoriasiform epidermal hyperplasia. CD30+ large cell transformation was present in the lymph node. Adenopathy and erythroderma resolved without systemic therapy following discontinuation of cyclosporine and treatment with psoralen/ultraviolet A (PUVA), isotretinoin, interferon-alpha, and antimicrobials.


CONCLUSIONS
This case documents a close relationship between atopy, psoriasis, and the development of cutaneous T-cell lymphoma, and illustrates that an immunosuppressive agent, cyclosporine, can dramatically alter the course of the disease.
Pielop
J A
JA
Baylor College of Medicine, Houston, Texas, USA.
Jones
D
D
Duvic
M
M
D000328:Adult; D001706:Biopsy / Q000379:methods; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D003876:Dermatitis, Atopic / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017728:Lymphoma, Large-Cell, Anaplastic / Q000139:chemically induced / Q000473:pathology*; D008297:Male; D009182:Mycosis Fungoides / Q000188:drug therapy / Q000473:pathology*; D016133:Polymerase Chain Reaction; D011565:Psoriasis / Q000188:drug therapy / Q000473:pathology; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy
D007166:Immunosuppressive Agents; D016572:Cyclosporine