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- Presentation
Cutaneous Lymphoma or Not? - Drug Edition
Description
In the "Cutaneous Lymphoma or Not? - Drug Edition" presentation, Dr. Erica Wang focuses on case studies highlighting the impacts of medication on cutaneous lymphoma. The first case involves a 66-year-old male suspected of having mycosis fungoides due to prominent hyperpigmented patches developed after initiating multiple antihypertensive medications. Biopsies indicated sparse infiltration inconsistent with mycosis fungoides, and subsequent T cell receptor gene rearrangement revealed clonality, hinting at a neoplastic process. However, the patient's wife revealed he had taken trimethoprim-sulfamethoxazole, leading to a final diagnosis of fixed drug eruption, confirmed by a drug re-challenge. The second case is of a 61-year-old woman with a rash that developed after starting dupilumab for atopic dermatitis, leading to a diagnosis of folliculotropic mycosis fungoides and possible dupilumab-associated lymphoid reaction. The discussion emphasizes the importance of thorough drug history reviews and highlights the need for vigilance in identifying atypical presentations of cutaneous lymphoma, especially in older adults. Overall, the session underscores the interplay between drug administration and cutaneous lymphoma expression, and the potential for misdiagnosis in cases treated for presumed benign conditions.
View moreConclusions
- The patient's diagnosis was ultimately identified as a fixed drug eruption from Trimethoprim/Sulfamethoxazole, rather than mycosis fungoides.
- Clinico-pathologic correlation is essential for accurate diagnosis of cutaneous lymphoma, incorporating clinical history, morphology, pathology, and molecular studies.
- T-cell receptor clonality can sometimes be positive in benign reactive or inflammatory conditions and can be shared among different sites, complicating the diagnostic process.
- A thorough review of the patient's drug history is crucial in differentiating between drug-induced reactions and true lymphomatous processes.
- In the second case, stopping dupilumab led to the clearing of the rash, indicating a possible dupilumab-associated lymphoid reaction.
- Emerging evidence suggests that dupilumab may unmask subclinical cutaneous lymphoma or worsen the condition in some patients.
- Cutaneous T-cell lymphoma often mimics benign inflammatory conditions such as atopic dermatitis, particularly in patients over 60 years old.
- Hamp, A., Hanson, J., Schwartz, R.A., et al. Dupilumab-associated mycosis fungoides: a systematic review. Arch Dermatol Res 315, 2561-2569 (2023). https://doi.org/10.1007/s00403-023-02652-z
- Boesjes, C. M., van der Gang, L. F., Bakker, D. S., et al. Dupilumab-Associated Lymphoid Reactions in Patients With Atopic Dermatitis. JAMA Dermatol. 2023;159(11):1240-1247. doi:10.1001/jamadermatol.2023.3849
- Espinosa, M. L., Nguyen, M. T., Aguirre, A. S., et al. Progression of cutaneous T-cell lymphoma after dupilumab: Case review of 7 patients. Research Letter. Volume 83, Issue 1, P197-199, July 2020.