Cutaneous T lymphoma in a patient with rheumatoid arthritis
Abstract
Patients with RA are at increased risk for several disorders, including cancer, infection and cardiovascular diseases. Rates of hematological malignancies (i.e. lymphomas, myeloid leukaemia) are elevated in this patient population. This is a case of a 74 years old male patient with longstanding nodular and polyarticular RA, treated with etanercept and abatacept without efficacy, later rituximab 2 g/ yr for 3 years, with very good response. Maintenance treatment: tofacitinib 5 mg/d orally. In april 2016, he presented nodular and erytemathous lesions in legs, necrotizing ulcers in left leg, bullous lesions in feet and edema in lower limbs to thigh. Treatment stops. Skin biopsy: T cell cutaneous lymphoma with dermal and hypodermic commitment. First chemotherapy cycle (CHOP) well tolerated but after second CHOP cycle the patient presented bone marrow aplasia and died.References
I. Ekström K, Hjalgrim H, Brandt L, Baecklund E, Klareskog L, Ekbom A, et al. Risk of malignant lymphomas in patients with rheumatoid arthritis and in their first-degree relatives. Arth Rheum 2003; 48:963-70.
II. Georgescu L, Quinn GC, Schwartzman S, Paget SA. Lymphoma in patients with rheumatoid arthritis: association with the disease state or methotrexate treatment. Semin Arthritis Rheum 1997; 26:794-804.
III. Smitten AL, Simon TA, Hochberg MC, Suissa S. A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Research &Therapy 2008, 10:R45.
IV. Thomason RW, Craig FE, Banks PM, Sears DL, Myerson GE, Gulley ML. Epstein-Barr virus and lymphoproliferation in methotrexate-treated rheumatoid arthritis. Mod Pathol 1996; 9:261-6.
V. Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Feltelius N. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Ann Rheum Dis 2005; 64:1421-1426.
VI. Mariette X, Tubach F, Bagheri H, Bardet M, Berthelot JM, Gaudin P, Heresbach D, Martin A, Schaeverbeke T, Salmon D, Lemann M, Hermine O, Raphael M, Ravaud P. Lymphoma in patients treated with anti-TNF: results of the 3-year prospective French RATIO registry. Ann Rheum Dis 2010; 69:400-408.
VII. Toussirot É, Aubin F. RMD Open 2016.
VIII. Maldonado Cocco J, Citera G. et al. Reumatologia 2010. Ediciones Azzurras. Buenos Aires. pag 235-237.(245)
IX. Cancer Epidemiol Biomarkers Prev 2006; 15 (11). November 2006
X. Baecklund E, Ekbom A, Sparen P, Feltelius N, Klareskog L. Disease activity and risk of lymphoma in patients with rheumatoid arthritis: Nested case-control study. Br Med J 1998; 317:180-181.
XI. Baecklund E, Iliadou A, Askling J, Ekbom A, Backlin C, Granath F. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum 2006, 54:692-701.
XII. Llorca J, López-Díaz MJ, González-Juanatey C, Ollier WER, Martin J, González-Gay MA. Persistent chronic inflammation contributes to the development of cancer in patients with rheumatoid arthritis from a defined population of northwestern Spain. Semin Arthritis Rheum 2007; 37:31-38.
XIII. L itvinov Ivan, Shtreis Anna, Kobayashi Kenneth, Glassman Steven, Tsang Matthew, Woetmann Anders, Sasseville Denis, Ødum Niels, Duvic Madeleine. Investigating potential exogenous tumor initiating and promoting factors for Cutaneous T-Cell Lymphomas (CTCL), a rare skin malignancy. Oncoimmunology 2016, VOL. 0, NO. 0, e1175799.
XIV. Askling J, Fored CM, Baecklund E, Brandt L, Backlin C, Ekbom A. Haematopoietic malignancies in rheumatoid arthritis: Lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists. Ann Rheum Dis 2005; 64:1414-1420.
XV. Rheumatology 2012; 51(suppl 5):v38-v47.
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