Ciclosporin
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Non-Hodgkin’s lymphoma/leukaemia in an elderly patient: case report A 66-year-old man developed non-Hodgkin’s lymphoma/ leukaemia during long-term treatment with ciclosporin for severe generalised plaque-type psoriasis. The man, whose previous medication included methotrexate, began receiving ciclosporin 5 mg/kg/day. After about 6 years, his dosage was decreased to 3 mg/kg/day following significant improvement of his psoriasis. Around 6–7 years later, he suddenly developed bilateral, rapidly enlarging cervical and inguinal lymphadenopathies. Laboratory tests revealed the following: 0.4 x 109/L lymphocytes, 7.6 x 109/L neutrophils, C-reactive protein 5.35 mg/dL (< 0.3), serum interleukin-2 receptor 34 000 U/mL (135–483), and serum lactate dehydrogenase 390 U/L (115–230). Western blotting was positive for anti-human T-cell lymphotrophic virus type-1 (HTLV-1) antibody. Serological testing was consistent with an ancient Epstein-Barr virus infection. A stenotic change of the superior vena cava and numerous, enlarged mediastinal lymph nodes were shown on a CT scan. An effacement of his nodal architecture by a polymorphic population of large, atypical lymphoid cells was shown on inguinal lymph node biopsy; there were numerous mitotic figures. On immunohistochemical examination, most of his atypical lymphoid cells were negative for CD20 and CD8, but positive for CD3 and CD4. Monoclonal integration of HTLV-1 provirus and clonality of the T-cell receptor β-chain gene rearrangement was shown on Southern blot hybridisation of a lymph node. He was diagnosed with lymphoma-type nonHodgkin’s lymphoma/leukaemia based on these findings [patient treatment and outcome not stated]. Author comment: The period of 13 years from the start of ciclosporin treatment to the presentation of lymphoma-type non-Hodgkin’s lymphoma/leukaemia and the fact that the patient had received other immunosuppressants which could have increased the risk of lymphoma development means that "[i]t is difficult to argue that the low dose of [ciclosporin] was directly related to the development of [non-Hodgkin’s lymphoma/leukaemia] in our patient". Watabe H, et al. Adult T-cell lymphoma/leukaemia developing in a patient with psoriasis treated with long-term cyclosporine. Acta Dermato-Venereologica 86: 801040987 184-185, No. 2, Mar 2006 - Japan
0114-9954/10/1113-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 5 Aug 2006 No. 1113
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