A Case of Mycosis Fungoides with Large Cell Transformation Associated with Infliximab Treatment

Suga, Hiraku; Sugaya, Makoto; Toyama, Tetsuo; Sumida, Hitoshi; Fujita, Hideki; Kogure, Asako; Igarashi, Atsuyuki; Sato, Shinichi

doi:10.2340/00015555-1675

Cited by 20 publications

(27 citation statements)

References 11 publications

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“…Large‐cell transformation in MF is uncommon, and extremely rare at that stage. In agreement with Suga et al ., who reported the exacerbation of a case of MF with large‐cell transformation during infliximab treatment, we believe that the latter may contribute to disease transformation . Furthermore, the patient had an aggressive clinical course with rapid disease progression to the tumour stage, suggesting that infliximab may play a direct role as a cofactor in T‐cell proliferation, in addition to the ciclosporin‐induced long‐standing immunosuppression.…”

Section: Clinical Characteristics and History Of Patients Diagnosed Wmentioning

confidence: 80%

Mycosis fungoides in the era of antitumour necrosis factor‐α treatments

et al. 2015

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Section: Clinical Characteristics and History Of Patients Diagnosed Wmentioning

confidence: 80%

Mycosis fungoides in the era of antitumour necrosis factor‐α treatments

et al. 2015

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“…Other skin diseases such as cutaneous T-cell lymphoma (CTCL), drug eruption, and bullous diseases should be considered as a possible diagnosis. Most of all, CTCL should not be misdiagnosed with AD because immunosuppressive drugs such as cyclosporine and anti-tumor necrosis factor (TNF)-α antibody can exacerbate disease activity of CTCL [5][6][7]. When the diagnosis is not clear, topical steroid or ultraviolet phototherapy should be applied.…”

Section: Introductionmentioning

confidence: 99%

The Role of Th17-Related Cytokines in Atopic Dermatitis

Sugaya

2020

IJMS

134

102

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T helper-17 (Th17) cells, which mainly produce IL-17, are associated with development of various autoimmune diseases such as rheumatoid arthritis, inflammatory bowel diseases, multiple sclerosis, and psoriasis. IL-17 and related cytokines are therapeutic targets of these diseases. In atopic dermatitis (AD), Th2 cytokines such as IL-4 and IL-13 are regarded to be the main player of the disease; however, Th17 cytokines are also expressed in AD skin lesions. Expression of IL-22 rather than IL-17 is predominant in AD skin, which is contrary to cytokine expression in psoriasis skin. Relatively low IL-17 expression in AD skin can induce relatively low antimicrobial peptide expression, which may be a reason why bacterial infection is frequently seen in AD patients. Failure of clinical trials for investigating the efficacy of anti-IL-12/23 p40 in AD has suggested that IL-17 expressed in skin lesions should not be the main player but a bystander responding to barrier dysfunction.

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“…The rarity of tumor‐stage MFPP raises consideration that our patient's progression to tumor stage may have been associated with TNF‐α inhibitors (etanercept and adalimumab), and mycophenolate mofetil. Although the association between immunosuppression and cutaneous lymphoma remains unclear, there have been reports of patients developing transformed MF after treatment with TNF‐α inhibitors . Nikolaou et al reported a series of 8 patients with histologically‐confirmed psoriasis who received TNF‐α inhibitors and subsequently developed MF .…”

Section: Discussionmentioning

confidence: 99%

Tumor‐stage mycosis fungoides in palmoplantar localization with large‐cell transformation and partial CD30 expression shows complete response to brentuximab vedotin

et al. 2018

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Mycosis fungoides in palmoplantar localization (MFPP) is a rare variant of MF that is confined to the hands and feet. Patients commonly receive treatment over many years for suspected palmoplantar dermatitis before the diagnosis is made. Most MFPP patients remain at patch or plaque stage, and often respond to treatment with radiotherapy. Herein, we describe a 77-year-old man who suffered 6 years of hand and foot dermatitis that failed multiple treatments, most notably TNF-α inhibitors and mycophenolate mofetil. He eventually developed a tumor on the hand, which was biopsied to reveal a dense dermal infiltrate of large lymphocytes (CD3+/CD4-/CD8-/TCR-BetaF1+/partial CD30+). A subsequent biopsy of an eczematous patch from his hand revealed an epidermotropic and syringotropic infiltrate comprised of smaller lymphocytes with a concordant immunophenotype and matching clonal peak with TCR gene rearrangement. He was diagnosed with MFPP and started on radiotherapy with a modest response; therefore, a decision was made to start brentuximab vedotin, which resulted in a complete response. MFPP is an exceedingly rare variant of MF that can show large-cell transformation and progress in stage. We highlight a possible association between disease progression and immunosuppressants and the potential role for treatment with brentuximab.

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A Case of Mycosis Fungoides with Large Cell Transformation Associated with Infliximab Treatment

Cited by 20 publications

References 11 publications

Mycosis fungoides in the era of antitumour necrosis factor‐α treatments

Mycosis fungoides in the era of antitumour necrosis factor‐α treatments

The Role of Th17-Related Cytokines in Atopic Dermatitis

Tumor‐stage mycosis fungoides in palmoplantar localization with large‐cell transformation and partial CD30 expression shows complete response to brentuximab vedotin

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