Rapid Occurrence of Nodular Cutaneous T-Lymphocyte Infiltrates With Cyclosporine Therapy

Abstract

Cyclosporine, a potent immunosuppressive agent, has been successfully used in the treatment of several dermatologic conditions including psoriasis. However, the drug does have an array of toxic side effects that need to be carefully considered when determining the risk-benefit ratio for the treatment of skin disease. We present another potential adverse effect of cyclosporine, namely, a benign lymphocytic infiltrate. This eruption developed in a patient with psoriasis after only ten days of cyclosporine therapy. The exact mechanism by which cyclosporine induced the lymphocytic infiltrate is unknown, but it is postulated that cyclosporine caused an imbalance of T-cell regulatory systems, thus resulting in an expanded T-cell subpopulation and the clinical manifestation of erythematous papules and nodules.

Cutaneous B cell Pseudolymphoma in a Psoriatic Patient Treated with Cyclosporine

“…However, uncertainty remains regarding whether the patients with malignant conversion initially had lymphomas that were histologically misdiagnosed or whether they initially harboured lymphocyte clones as an early step in a multistep progression pathway to cutaneous lymphoma (6). Lymphocytic infiltrate of the skin (pseudolymphoma), involving mainly T cells, has been reported following Cys treatment (5). Pseudolymphoma has also been described in association with tattoos, vaccinations, infections, drugs and inflammatory dermatoses, even though most cases are idiopathic (8).…”

“…Pseudolymphoma has been reported in psoriatic patients treated with Cys (2), infliximab (3,4) or adalimumab (4). Cys is an immunosuppressant that acts via binding to the T-cell cytosolic protein, cyclophilin, and several cases of Cys-related T-cell pseudolymphoma have been reported (3,5). We report here a psoriatic patient who received long-term Cys treatment and developed B-cell pseudolymphoma on his face and ear.…”