Methotrexate and etanercept-induced primary cutaneous CD4 positive small/medium-sized pleomorphic T-cell lymphoma

Abstract

Immunosuppressive drugs and biological agents may represent a potential risk of lymphoma development in patients with rheumatoid arthritis. But most cases are diffuse, large B-cell lymphomas. Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, a provisional entity in the 2005 WHO-EORTC classification of cutaneous lymphomas, is only described in a limited number of reports. To our knowledge, our case is a rare instance of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, after associated treatment with methotrexate and etanercept, in a patient with moderate rheumatoid arthritis who had undergone an orchidectomy incorrectly.

Case for diagnosis. Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder

“…1 Cases have been described in patients with some degree of immune compromise such as transplanted patients and those in use of immunobiologicals. 2,3…”

Primary cutaneous CD4+ small/medium pleomorphic T‐cell lymphoproliferative disorder: Where do we stand? A systematic review

“…A few unusual clinical presentations have been reported such as acneiform , alopecia and leprosy‐like disease . Drug‐induced PCSMP‐TLPD has also been reported for the methotrexate‐etanercept combination , vemurafenib , interleukin (IL)‐2 therapy for metastatic melanoma and standard triple‐agent immunosuppressive therapy (cyclosporine, prednisolone, and azathioprine) following heart transplantation surgery , although this is an extremely rare presentation. This drug‐induced variant should be carefully differentiated from drug‐induced nodular T‐cell pseudolymphoma.…”

“…Furthermore, a child with a unique association of PCSMP‐TLPD and erythema chronicum migrans showed complete remission with oral amoxicillin . Finally, PCSMP‐TLPD has also been associated with advanced melanoma (n = 2) , superinfection of an ulcerative lesion with zygomycosis (n = 1) and rheumatoid arthritis (n = 1) .…”

Primär kutane CD4+ klein‐ bis mittelgroßzellige pleomorphe T‐Zell‐Lymphoproliferation: Wo stehen wir? Eine systematische Übersicht

“…Es wurde auch über einige wenige atypische klinische Manifestationen berichtet, wie Akne‐ oder Lepra‐ähnliche Veränderungen und Alopezie [–]. Des Weiteren wurde nach Behandlung mit der Kombination Methotrexat‐Etanercept , mit Vemurafenib , Interleukin (IL)‐2 bei metastasiertem Melanom und immunsuppressiver Dreifachstandardtherapie (Cyclosporin, Prednisolon und Azathioprin) nach Herztransplantation über arzneimittelinduzierte PCSMP‐TLPD berichtet, wobei dies jedoch äußerst selten ist. Die arzneimittelinduzierte Variante sollte sorgfältig vom arzneimittelinduzierten nodulären T‐Zell‐Pseudolymphom unterschieden werden.…”

“…In diesem Fall wurde durch orale Behandlung mit Amoxicillin eine komplette Remission erzielt . Schließlich gab es auch Fälle, bei denen die PCSMP‐TLPD auch mit fortgeschrittenem Melanom (n = 2) , Superinfektion einer ulzerierenden Läsion mit Zygomyzeten (n = 1) und rheumatoider Arthritis (n = 1) assoziiert war.…”