title: A unique CD4+ large granular lymphocytosis occurring in patients treated with tumor necrosis factor α inhibitors: report of 2 cases.
abstract: We report 2 cases of CD4(+) large granular lymphocyte (LGL) lymphocytosis occurring in patients being treated with a monoclonal antibody against tumor necrosis factor α for underlying autoimmune disorders. CD4(+) LGL lymphocytosis is a rare subset of LGL disease that has previously only been described in patients without underlying autoimmune disorders, and most demonstrate uniform coexpression of CD56 on the atypical T cells. The clinical features, with both cases occurring in patients with autoimmune disease, and immunophenotypic features, with both cases showing dim CD8 coexpression without CD56 in the CD4(+) LGLs, suggest that the reported cases are distinct from those previously described and may represent a novel T-cell LGL lymphocytosis emerging from iatrogenic immune modulation of patients with underlying autoimmune disorders.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI.
authors.forename: Adam
authors.initials: A
authors.lastname: Covach
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI.
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Leith
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, WI.
authors.forename: Saurabh A
authors.initials: SA
authors.lastname: Rajguru
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI. Electronic address: dtyang@wisc.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Yang
mesh_terms: D000068879:Adalimumab; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D018771:Arthralgia / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D008218:Lymphocytosis / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D025242:Spondylarthropathies / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab
keywords: Adalimumab; CD4; LGL; Large granular lymphocytosis; T cell; Tumor necrosis factor α