Erythrodermic cutaneous T-cell lymphoma: Two case reports / Eritrodermalni kutani limfom T-ćelija - prikaz dva slučaja

Miroslav Ž. Dinić 1 , Lidija Kandolf-Sekulovi 1 , Tomislav Mladenović 1 , and Radoš D. Zečević 1
  • 1 Department of Dermatology and Venereology, Military Medical Academy, Belgrade


Primary cutaneous T-cell lymphomas (CTCLs) are Non-Hodgkin lymphomas where skin may be the only involved organ for a long time. The erythrodermic form of CTCL, including Sezary syndrome, with increased IgE concentration, eosinophilia and intense pruritus, may suggest atopic dermatitis, in the lack of evidence for diagnosis of T-cell lymphoproliferative disorder. After vigorous research, two patients with erythroderma, increased IgE and eosinophilia, were not diagnosed with CTCL. Adult atopic dermatitis was diagnosed, based on clinical examination and histopathologic analysis of the skin sample. Therapy with oral cyclosporin A (CsA) and systemic corticosteroids were initiated, but the improvement was minimal and short-lived. Disease progression was noted in both patients, after a month of cyclosporine therapy: malaise, subfebrile and febrile temperatures, and development of generalized skin nodules were evident. In the first patient (aged 30) repeated examinations confirmed presence of Sezary cells in peripheral blood samples, dominant T-cell clone in the skin, peripheral blood and bone marrow, whereas the last repeated histopathologic analysis revealed T-lymphoproliferative skin disorder. In the second patient, (aged 44) primary cutaneous CD30+ T-cell lymphoma was diagnosed, based on histopathologic analysis of the newly appearing skin nodule. Differential diagnosis of erythroderma is always difficult, since clinical, histopathologic and immunophenotypic findings are frequently insufficient to differentiate between inflammatory and lymphomatous erythroderma. Treatment with cyclosporin A always demands carefull evaluation of the course of the disorder.

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  • 1. Olsen E, Vonderheid E, Pimpinelli N, Willemze R, Kim Y, Knobler R, et al. Revisions to the staging and classification of mycosis fungoides Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007;110:1713-22.

  • 2. Kandolf-Sekulović L, Cikota B, Dinić M, Škiljević D, Medenica Lj, Magić Z. T-cell receptor-γ gene rearrangement analysis in the diagnosis of patients with erythroderma. Serb J Dermatol Venereol 2009;1:17-26.

  • 3. Willemze R, Jaffe E, Burg G, Cerroni L, Berti E, Swerdlow S, et al. WHO-EORTC classification for cutaneous lymphomas. Blood 2005;105:3768-85.

  • 4. Goyal S, Brinster NK, Goyal S. Ki-1(CD30) positive anaplastic large cell lymphoma: primary nodal disease relapsing as erythroderma. J Am Acad Dermatol 2002;47:S201-4.

  • 5. Denton K, Wilson CL, Venning VA. Primary cutaneous anaplastic large-cell lymphoma with a prolonged erythrodermic prodrome. Br J Dermatol. 1992;126:297-300.

  • 6. Mougel F, Dalle S, Balme B, Houot R, Thomas L. Aggresive CD30 large cell lymphoma after cyclosporine given for putative atopic dermatitis. Dermatology 2006;213:239-41.

  • 7. Laube S, Stephens M, Smith AG, Whitaker SJ, Tan BB. Lymphomatoid papulosis in a patient with atopic eczema on long-term cyclosporine therapy. Br J Dermatol 2005;152: 1346-1348.

  • 8. Mehrany K, El-Azhary RA, Bouwhui SA, Pittelkow MR. Cutaneous T-cell lymphoma and atopy: is there an association? Br J Dermatol 2003;149:1013-7.

  • 9. Arellano F, Arana A, Wentworth C, Fernandez-Vidaurre C, Schlienger R, Conde E. Lymphoma among patients with atopic dermatitis and/or treated with topical immunosuppressants in the United Kingdom. J Allergy Clin Immunol 2009;123:1111-6.

  • 10. Meyer N, Mazereeuv-Hautier J, Launay F, Lamant L, Paul C. CTCL complicating severe atopic dermatitis. Dermatology 2009;218:168-71.


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