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Follicular Eruption With Folliculotropic Lymphocytic Infiltrates Associated With Iatrogenic Immunosuppression: Report and Study of 3 Cases, and Review of the Literature
- Source :
- The American Journal of dermatopathology. 42(7)
- Publication Year :
- 2019
-
Abstract
- Background Several cases of folliculotropic mycosis fungoides, associated with immunosuppressive therapy, including calcineurin inhibitors, have been reported in solid organ transplant patients. We have encountered 3 patients on immunosuppressive therapy who developed follicular eruptions with folliculocentric infiltrates of nonatypical lymphocytes. Objective To characterize these follicular eruptions and review the literature. Methods Three patients, aged 7-15 years, who were treated with systemic immunosuppressive therapy developed follicular eruptions characterized histopathologically by folliculocentric lymphocytic infiltrates. These were studied clinically, histopathologically, immunophenotypically, and molecularly for T-cell receptor (TCR) gene rearrangement. Results All 3 cases were characterized histopathologically by folliculocentric infiltrates of nonatypical CD3 T lymphocytes with variable follicular exocytosis. Two cases also showed follicular mucinosis. Marked reduction in CD7 staining, and marked predominance of CD4 cells over CD8 cells was observed in all 3 cases. The TCR gene rearrangement studies were monoclonal in 2 cases. Oral calcineurin inhibitors (2 cyclosporine A and 1 tacrolimus) were part of the therapeutic regimen in all 3 patients. Their cessation along with local corticosteroid creams in 2 patients, and phototherapy with oral acitretin in one patient, was associated with complete clinical remission. Conclusions Patients undergoing systemic immunosuppressive therapy that includes calcineurin inhibitors might develop follicular eruption with some immunophenotypical variations and a monoclonal TCR gene rearrangement but lack sufficient cytomorphological features of folliculotropic mycosis fungoides. Altering the immunosuppressive agent including calcineurin inhibitors may result in regression of the eruptions.
- Subjects :
- Male
Pathology
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Iatrogenic Disease
Dermatology
Pathology and Forensic Medicine
Acitretin
030207 dermatology & venereal diseases
03 medical and health sciences
Immunocompromised Host
0302 clinical medicine
medicine
Humans
Child
business.industry
Immunosuppression
General Medicine
Gene rearrangement
Exanthema
Folliculotropic Mycosis Fungoides
Tacrolimus
Calcineurin
Monoclonal
business
CD8
Immunosuppressive Agents
medicine.drug
Subjects
Details
- ISSN :
- 15330311
- Volume :
- 42
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- The American Journal of dermatopathology
- Accession number :
- edsair.doi.dedup.....f4e3575d863bae499adb9a1c63899b31