Development of Cutaneous Pseudolymphoma Following Ciclosporin Therapy of Actinic Reticuloid

Abstract

The patient is a 57-year-old man with actinic reticuloid, who despite systemic prednisone, azathioprine, topical steroid, and sun-protective cream had to stay indoors in the summer of 1986. In February 1987 he was started on ciclosporin (CS), 5.5 mg per kg body weight, and skin symptoms did not develop as usual in spring and summer 1987. Following 4 months of succesful therapy, he developed an indolent tumor on his right chin and parapsoriasis en plaque on the lower arms and legs. Histological examinations of the tumor showed an intense lymphoid infiltrate of a pseudolymphomatous type. The tumor regressed partly following discontinuation of CS, but additional radiation therapy had to be administered. His clinical symptoms of actinic reticuloid reappeared. Eight months after CS treatment he developed a malignant T cell lymphoma with metastasis in the regional lymph nodes on the neck. CS should not be used in diseases with potential premalignant features even though its therapeutic efficacy in actinic reticuloid was impressive.

Drug-Induced Pseudolymphoma and Hypersensitivity Syndrome

“…Some other cases could not be in¬ cluded because the observations provided insufficient de¬ tails: age, delay, clinical findings, biological counts, and evo¬ lution. As in our 24 patients, we were able to separate these 29 of the 95 patients, so the results may be not reliable. Lymph node biopsy was done in 17 patients and showed dermopathic lymphadenopathy in 12 patients and a picture evocative of lymphoma in 5.…”

“…In all cases, skin healing occurred when the drug was stopped. There was a relapse in 1 patientonly,215 months after the first eruption, and 1 case of lymphoma occurred several years later, as it was originally reported 29,31. In the other 95 cases, the cutaneous eruption had a rapid onset and was polymorphous: maculopapular rash, with facial edema, often generalized in exfoliative derma¬ titis.…”

Kaposi-Sarkom unter Cyclosporin-A-Therapie bei aktinischem Retikuloid

“…Bisher wurde einzig über das Auftreten eines Pseudolymphoms bei einem Patienten mit AR unter immunsuppressiver Therapie mit CsA berichtet [25]. Bei dem hier vorgestellten Patienten handelt es sich um die Erstbeschreibung eines iatrogenen KS nach einer 11monatigen CsA-Behandlung bei aktinischem Retikuloid.…”

Cyclosporin A in chronic actinic dermatitis

“…Side effects have been registered in only two cases. Parapsoriasis en plaques and then a malignant T lymphoma developed in one patient and CyA had to be discontinued [2]. CyA treatment was directly related to the development of the malignancy, but it had been too short for a coincidental association to be ruled out.…”