Late-onset bexarotene-induced CD4 lymphopenia in a cutaneous T-cell lymphoma patient.
Various infections, autoimmune diseases, medications, and total-body irradiation are known factors associated with CD4 lymphopenia, defined as a CD4 T-cell count below 300 cells/mL or less than 20% of total lymphocytes. We report a rare case of a patient with cutaneous T-cell lymphoma (CTCL) who developed profound CD4 lymphopenia in the setting of long-term bexarotene therapy. Bexarotene is a third-generation retinoid that inhibits epithelial cell proliferation and is approved for treatment of advanced CTCL (stages IIB-IVB) in adult patients who have failed at least 1 prior systemic therapy. This case illustrates the importance of surveillance for CD4 leukopenia in patients on long-term bexarotene therapy with routine complete blood cell counts (CBC) and T-cell counts as well as consideration of rotating patients off bexarotene therapy even in those who derive continuous benefit.
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Karin
K
Eshagh
Department of Dermatology, University of California, San Diego, Medical Center, and VA San Diego Healthcare System, USA.
Laura S
LS
Romero
Department of Dermatology, Sharp Healthcare System, La Jolla, California, USA.
Jessica K
JK
So
Department of Pathology, Phoenix VA Health Care System, Arizona, USA.
Xianfeng Frank
XF
Zhao
D016588:Anticarcinogenic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000077610:Bexarotene; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy* / Q000473:pathology; D008231:Lymphopenia / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology; D013764:Tetrahydronaphthalenes / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors
D016588:Anticarcinogenic Agents; D013764:Tetrahydronaphthalenes; D000077610:Bexarotene