Palpable arciform migratory erythema in an HIV patient, a CD8<sup>+</sup> pseudolymphoma

Muche, J. Marcus; Toppe, Esdert; Sterry, Wolfram; Haas, Naomi B.

doi:10.1111/j.0303-6987.2004.00200.x

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…In syphilis and HIV co - infection , skin lesions have been reported as atypical cutaneous lymphoproliferative disorders in patients with HIV [ 14 ]. Tosca et al reported that lymphocytes can be of both the CD4 and CD8 types, [ 15 ] whereas Muche et al reported that 85 % of the skin-infiltrating lymphocytes in HIV patients were CD8+ T-cells [ 16 ]. However, the histopathological findings remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

et al. 2015

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Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.

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Section: Introductionmentioning

confidence: 99%

Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

et al. 2015

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“…Furthermore, an almost complete loss of CD4‐positive T‐cells should make one think of HIV‐associated PSL . CD8‐positive PSL in HIV patients have rarely been described . They typically affect patients with profound immunosuppression and a low CD4 count.…”

Section: Discussionmentioning

confidence: 99%

“…6 CD8-positive PSL in HIV patients have rarely been described. 5,6,10 They typically affect patients with profound immunosuppression and a low CD4 count. Clinically, they are characterized by erythematous plaques (sometimes progressing to erythroderma), scaling, palmoplantar keratoderma and enlarged lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement

Mitteldorf¹,

Plumbaum

Zutt

et al. 2018

J Cutan Pathol

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A 42‐year‐old Caucasian man suffered from disseminated plaques and ulcerated nodules for 6 weeks. He had weight loss and generalized lymphadenopathy. Underlying diseases were not known up till then. Based on a skin biopsy, the diagnosis of CD8‐positive cutaneous T‐cell lymphoma, type mycosis fungoides was made in a pathological reference center for lymphoma. A reproducible T‐cell receptor (TCR)‐beta rearrangement was detectable. Before starting therapy, a new biopsy was taken and the previous diagnosis was re‐evaluated taking clinical images and symptoms into account. Based on both, the diagnosis of a CD8+ pseudolymphoma in lues maligna and human immunodeficiency virus was made. We highlight histopathologic clues for the correct diagnosis, and we emphasize the indispensability of clinical‐pathological correlation. Furthermore, we discuss the differential diagnosis of CD8+ lymphoproliferative disorders.

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“…DISCUSSION T-cell pseudolymphomas including PAME are characterized by the proliferation of benign hyperplastic T cells, mostly of the CD4 phenotype (2-4, 8, 9). with the exception being CD8-dominant PAME in an HIV-infected individual (5), Although the aetiology is unknown in most cases, T cells persistently accumulate and proliferate in response to a variety of stimuli. The high proportion of CD8' T cells among lymphocytic infiltrate in CD4' T-cell pseudolytnphoma rnay retiect an eftective host immune response against proliferating CD4* cells, which prevents further progression ( 10), A unique clinical feature of our patient was that PAME developed surrounding preceding B-cell pseudolymphoma.…”

Section: Case Reportmentioning

confidence: 99%

Palpable Archiform Migratory Erythema Preceded by B-cell Pseudolymphoma in a Japanese Man

Yanagimoto¹,

Ito²,

Ito³

et al. 2008

Acta Derm Venereol

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Sir.Palpable archiform migratory erythema (PAME) is a rare member of the family of T-cell pseudolymphomas occurring preferentially in adull males ( I -5 ). The clinical picture of PAME is distinctive from other pseudolymphomas because infiltrated annular erythema develops into elevated migrating lesions in the trunk as the predilection site. The aetiology of this condition is unknown and the disease runs a chronic course. We report here a case of PAME in which polyclonal populations of T cells proliferated surrounding a preceding B-cell pseudolymphoma. CASE REPORTA 66-year-old man h;id developed a red, small lump iO years previously and after 7 years arc-shaped eruptions began to appear surrounding this initial lesion. The initial examination revealed an indurated smooth surfaced nodule 2.5 cm in diameter surrounded hy arcbitbrm and annular, firm, palpable erythemas on the back (Fig, la). Tbere were no subjective symptoms or superficial lymphadenopathy. The central nodule gradually resolved in 3 months after the first visit to our clinic without any treatment. The archiforEii and annular erythemas waxed and waned, as a part of the lesions disappeared in 2-3 months while other parts tended to clear, without any systemic or topical treatment (Fig. Ib). While oral penicillin, topical steroids of strong potency, and intra-lesional and intravenous injections of interferon-Y(6) were ineffective, oral administration of prednisolone at a starting dose of 30 mg/day follov^-ed by dose-tapering completely cleared the lesions in 8 months.Laboratory findings including red and white blood cell counts, haemoglobin levels, serum electrolytes, liver enzyme levels.serum protein and immunoglobulin levels and C-reactive protein were normal on several occasions during our 3-ycar observation. Anti-nuclear antibodies, and antibodies to Trcponenuipalliilum, human T-lympholrople virus-1, human immunodetlciency virus, hepatitis C virus, and Borrelia hurgihrferi were always negative. Chest X-ray showed no abnormality, and there was no lyinphadenopathy or hepatosplenomegaly hy computerized tomography scanning. Bone marrow aspiration revealed normal cellular composition.In the central nodule, atypical lymphoid cells with large, irregularly shaped, pale nuclei and small lymphocytes lay either intermingled with one another or in a follicular arrangement in the entire upper dermis (Fig, 2a). Lymphoid follicular structures consisted of CD20' large atypical B and CD3' small T cells at a ratio of 9:1 (Fig, 2b). At resolution, mononuclear cell infiltrates localized to perivascular areas with less conspicuous follicular structures that consisted of almost equal numbers of CD20' and CD3' cells. Specimens obtained from arciform erythema on 3 occasions at different siles consistently revealed a dense lymphocytic infiltrate around the blood vessels and hair follicles in the upper and mid dermis, with a CD3 ' to CD20" cell ratio of 7 to 3 (Fig, 3). No follicular structure was apparent. In addition, helper T cells outnumbered cytotoxic T cells since CD4" ...

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Palpable arciform migratory erythema in an HIV patient, a CD8⁺ pseudolymphoma

Abstract: PAME may also occur in HIV-positive patients with CD4+ deficiency. Our case demonstrates that regular CD4 counts and immunocompetence are not necessary for its pathogenesis.

Cited by 13 publications

References 17 publications

Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement

Palpable Archiform Migratory Erythema Preceded by B-cell Pseudolymphoma in a Japanese Man

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Palpable arciform migratory erythema in an HIV patient, a CD8+ pseudolymphoma

Abstract: PAME may also occur in HIV-positive patients with CD4+ deficiency. Our case demonstrates that regular CD4 counts and immunocompetence are not necessary for its pathogenesis.

Cited by 13 publications

References 17 publications

Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement

Palpable Archiform Migratory Erythema Preceded by B-cell Pseudolymphoma in a Japanese Man

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Palpable arciform migratory erythema in an HIV patient, a CD8⁺ pseudolymphoma