Adnexotropic and granulomatous mycosis fungoides following TNF‐α inhibitor treatment

Abstract

Recent publications have documented an increased prevalence of cutaneous T-cell lymphoma (CTCL) in patients undergoing tumor necrosis factor alpha (TNF-α) inhibitor therapy. Herein, we present an uncommon manifestation of mycosis fungoides (MF) with unique pathological findings after the initiation of adalimumab therapy for the treatment of psoriasis. One year after starting treatment, the patient noticed a slowly growing, eroded plaque on the left cheek, the biopsy of which demonstrated mixed granulomatous and adnexotropic lymphocytic infiltrate with features characteristics of MF. In the following months, the patient developed pink-and violetcolored scaly plaques on the right posterior upper arm and right medial upper arm. Biopsy of these plaques also revealed findings compatible with MF. T-cell receptor (TCR) clonality studies by PCR revealed identical T-cell clones in the samples obtained from the cheek, right posterior upper arm, and right medial upper arm. TCR clonality studies of a long-standing psoriatic plaque on the right thigh failed to reveal similar T-cell clones. Blurring of histopathologic presentation by TNF-α inhibitors could greatly complicate the identification of MF subtypes. Providers treating patients with TNF-α inhibitors must be aware of the risk of cutaneous lymphoma development and the potential deviations from their expected presentations. In patients without an initial biopsy, the possibility of pre-existing CTCL with psoriasiform presentation should be considered.

Application of Data Mining in Pharmaceutical Research

“…A meta-analysis showed that treatment with anti-TNFα agents increased the risk of serious infections (OR: 1.72, 95% CI: 1.56-1.90, p < 0.00001) and an increase in cancer risk (OR: 1.36, 95% CI: 1.20-1.53, p < 0.00001), whereas the risk of tuberculosis was not significantly different (Li et al, 2021). Although there was no consensus on the risk of infection associated with anti-TNFα treatments in published clinical trials, post-marketing surveillance and retrospective studies have shown an increased risk of tuberculosis and other granulomatous infections (Wallis et al, 2004;Godfrey and Friedman, 2019;Athimni et al, 2022;Doughty et al, 2023). A meta-analysis carried out in 2006 showed an increase in the risk of malignancies and serious infections in patients treated with infliximab and adalimumab, where a higher dose was associated with increased cancer risk (Galloway et al, 2011).…”

Characteristic analysis of adverse reactions of five anti-TNFɑ agents: a descriptive analysis from WHO-VigiAccess

“…A meta-analysis showed that treatment with anti-TNFα agents increased the risk of serious infections (OR: 1.72, 95% CI: 1.56–1.90, p < 0.00001) and an increase in cancer risk (OR: 1.36, 95% CI: 1.20–1.53, p < 0.00001), whereas the risk of tuberculosis was not significantly different ( Li et al, 2021 ). Although there was no consensus on the risk of infection associated with anti-TNFα treatments in published clinical trials, post-marketing surveillance and retrospective studies have shown an increased risk of tuberculosis and other granulomatous infections ( Wallis et al, 2004 ; Godfrey and Friedman, 2019 ; Athimni et al, 2022 ; Doughty et al, 2023 ). A meta-analysis carried out in 2006 showed an increase in the risk of malignancies and serious infections in patients treated with infliximab and adalimumab, where a higher dose was associated with increased cancer risk ( Galloway et al, 2011 ).…”