title: Sézary syndrome and seronegative polyarthritis: treatment with extracorporeal photochemotherapy.
abstract: We describe a patient with therapy-resistant cutaneous T-cell lymphoma, Sézary syndrome variant, in association with concurrent polyarthritis and vitiligo, who was successfully treated with extracorporeal photochemotherapy (ECP). The combination of Sézary syndrome with seronegative rheumatoid arthritis is rare. In our patient the T-cell lymphoma was refractory to standard treatments that included psoralen-UVA, lymph node irradiation, and polychemotherapy. ECP has been shown to be effective in the treatment of selected cases of Sézary syndrome. There is a strong suggestion that ECP as a monotherapy can provide a significant benefit for other T-cell-mediated diseases including rheumatoid arthritis. In spite of a disease duration of 10 years, a very low CD8 cell count (2% of lymphocytes), a very high CD4 cell count (94%), and multiple unsuccessful chemotherapeutic trials before initiation of ECP, our patient achieved a long-lasting complete remission of both diseases with normalization of the CD4+ and CD8+ T-lymphocyte subsets. Concurrent developing vitiligo was unaffected by ECP.
authors.affiliation: Department of Dermatology, Division of Special and Environmental Dermatology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Macheiner
authors.forename: Christian
authors.initials: C
authors.lastname: Jantschitsch
authors.forename: Winfried
authors.initials: W
authors.lastname: Graninger
authors.forename: Katalin
authors.initials: K
authors.lastname: Pálóczy
authors.forename: Géza
authors.initials: G
authors.lastname: Bálint
authors.forename: Márta
authors.initials: M
authors.lastname: Marschalkó
authors.forename: Franz
authors.initials: F
authors.lastname: Kainberger
authors.forename: Friedrich
authors.initials: F
authors.lastname: Breier
authors.forename: Robert M
authors.initials: RM
authors.lastname: Knobler
mesh_terms: D001168:Arthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D011859:Radiography; D012751:Sezary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology