Sudden onset of an aggressive cutaneous lymphoma in a young patient with psoriasis: role of immunosuppressants.
Psoriasis is thought to be associated with an increased risk of lymphoma. We report here the first case of an aggressive primary cutaneous pleomorphic T-cell lymphoma in a patient with psoriasis. The 36-year-old patient, who had previously been treated successively with methotrexate, ciclosporin and etanercept, presented with rapidly growing nodules on the leg. A biopsy confirmed a stage IVa primary cutaneous pleomorphic T-cell lymphoma. Despite treatment with pegylated liposomal doxorubicin, the disease progressed and the patient died 5 months later. This case of pleomorphic T-cell lymphoma was remarkable in both its extremely rapid onset and the aggressive nature of the disease. The onset of this disease in a patient with psoriasis who had been previously treated with immunosuppressive drugs and a tumour necrosis factor (TNF)-α blocker is of major interest. Only eight cases of cutaneous lymphomas associated with treatment with TNF-α blockers have been published previously. Most of these eight cases related to anti-TNFα antibodies; only two were linked to etanercept.
Nantes University Hospital, INSERM, Nantes, France.
Gaëlle
G
Quéreux
Jean-Jaques
JJ
Renaut
Lucie
L
Peuvrel
Anne-Chantal
AC
Knol
Anabelle
A
Brocard
Brigitte
B
Dréno
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001706:Biopsy; D016572:Cyclosporine / Q000009:adverse effects; D004317:Doxorubicin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068800:Etanercept; D017809:Fatal Outcome; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007866:Leg; D016410:Lymphoma, T-Cell, Cutaneous / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D017211:Treatment Failure
D000903:Antibiotics, Antineoplastic; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; C506643:liposomal doxorubicin; D011092:Polyethylene Glycols; D004317:Doxorubicin; D016572:Cyclosporine; D000068800:Etanercept; D008727:Methotrexate