Progression of mycosis fungoides after treatment with dupilumab: A case report

Abstract

crucial. In this era of biologic therapies, misdiagnosis, and the use of inappropriate drugs in CTCL may lead to catastrophic outcomes. If dupilumab had a role in progression or histopathological presentation is unknown. More studies are needed, and a more accurate and careful indication of biologic therapies is imperative. CONFLICT OF INTEREST The authors declare no conflicts of interest. AUTHOR CONTRIBUTIONS Denis Miyashiro designed the research, gathered and analyzed the data, and wrote the majority of the manuscript. Ana Gabriela Vivarelli gathered and analyzed the data and wrote part of the manuscript. Fernanda Gonçalves gathered and analyzed the data and wrote part of the manuscript. Jade Cury-Martins analyzed the data. José Antonio Sanches designed the research, analyzed the data, and wrote part of the manuscript. All authors have read and approved the submitted version of the manuscript.

Cellular Interactions and Inflammation in the Pathogenesis of Cutaneous T-Cell Lymphoma

“…Indeed, administration of Toll-like receptor (TLR) agonists boosting cellular immunity has shown clinical efficacy, and treatment with IL-12 and IFNγ can induce regression of CTCL lesions which is associated with increased numbers of CD8 T cells in the resolving skin ( Rook et al, 1999 , 2001 , 2015 ; Suchin et al, 2002 ; Dummer et al, 2004 ; Duvic et al, 2006 ; Wysocka et al, 2007 ; Kim et al, 2010 ; Accart et al, 2013 ). Of notice, recent case reports have surprisingly described that long-term treatment with dupilumab, a neutralizing antibody targeting IL-4 receptor alpha, may exacerbate CTCL and possibly even trigger the disease in certain patients with severe atopic dermatitis (AD) ( Chiba et al, 2019 ; Espinosa et al, 2020 ; Miyashiro et al, 2020 ; Tran et al, 2020 ; Umemoto et al, 2020 ). While substantial data currently support that the transition from a Th1- to a Th2-biased tumor microenvironment contributes to the progression of CTCL, these new findings suggest that the role of the cytokine milieu might be more complex than appreciated thus far.…”

Atopic Dermatitis with Multiple Comorbidities Treated with Dupilumab. A Case Report and Review of the Literature Regarding the Safety of Dupilumab

“…Although Dupilumab seemed to temporarily improve pruritus and erythema, available clinical data suggest that long-term usage can lead to the worsening or progression of CTCL. In all analyzed cases in which the initial diagnosis was that of AD based on clinical and laboratory findings after Dupilumab treatment, the diagnosis was changed to CTCL because of unsatisfactory clinical responses, which led to repeated investigations [ 33 , 34 , 35 , 36 ]. These cases could be interpreted as misdiagnosed AD, which eventually proved to be CTCL, but no signs of CTCL were seen during investigations prior to the administration of Dupilumab.…”

Successful Treatment of Atopic Dermatitis with Dupilumab in a Patient with Non-Hodgkin’s Lymphoma

“…Experts suspect eczematous skin lesions may occur as a symptom of undiagnosed CTCL, especially in adult patients with late-onset AD ( 6 ). Some studies have described the progression of CTCL after receiving dupilumab therapy for presumed atopic dermatitis ( 7 , 8 ). However, systemic immunosuppressors were not considered, due to the potential to cause lymphoproliferative diseases and malignancies.…”