CD30+ T-cell lymphoma in a patient with psoriasis treated with ciclosporin and infliximab.
There is a known relationship between the use of immunosuppressive therapies and the development of lymphoproliferative malignancies. These lymphomas are mainly B-cell nonHodgkin's lymphomas associated with Epstein-Barr virus. Most cases concern classical immunosuppressive treatments including ciclosporin and methotrexate. A relationship between the new antitumour necrosis factor (TNF)-alpha agents and lymphoproliferative malignancies is debated. Patients with psoriasis on immunosuppressive therapies, mainly ciclosporin, are considered to have a low risk of developing lymphoid proliferation. We report a patient with erythrodermic psoriasis treated with ciclosporin and infliximab who developed a CD30+ T-cell lymphoma. This lymphoma regressed after stopping these treatments. In this case, the anti-TNF-alpha agent may have played a role in association with ciclosporin in the development of the lymphoproliferative disorder. Whereas the combination of anti-TNF-alpha therapies with methotrexate has been well studied, their combination with ciclosporin has been evaluated only in a few patients. Psoriatic patients who may require anti-TNF-alpha treatment have often been or will be treated with ciclosporin. The combination of ciclosporin and anti-TNF-alpha warrants further investigation.
Mahé
E
E
Department of Dermatology, Bichat-Claude Bernard Hospital, 46 Rue Henri-Huchard, Paris Cedex 18, France. emmanuel.mahe@bch.ap-hop-paris.fr
Descamps
V
V
Grossin
M
M
Fraitag
S
S
Crickx
B
B
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D016572:Cyclosporine / Q000009:adverse effects*; D003879:Dermatologic Agents / Q000009:adverse effects; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D017728:Lymphoma, Large-Cell, Anaplastic / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000473:pathology
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab