In a recent clinical letter published by the Brazilian Society of Dermatology, researchers highlight the potential role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in triggering the relapse of mycosis fungoides, a type of cutaneous T-cell lymphoma.
Study: Recurrence of mycosis fungoides controlled after SARS-CoV-2 infection. Image credit: Kateryna Kon/Shutterstock
Targets
The authors aimed to discuss a report describing the recurrence of mycosis fungoides in a patient after contracting coronavirus disease 2019 (COVID-19). They described the symptoms and tests that confirmed COVID-19 and the recurrence of mycosis fungoides and discussed possible viral mechanisms that could cause immune dysregulation in patients with cutaneous T-cell lymphoma.
the report
The authors described the case of a 60-year-old female patient with mycosis fungoides, whose cancer was controlled by ultraviolet A phototherapy and 8-methoxypsoralen, followed by narrow-band ultraviolet B therapy. She contracted a SARS-CoV-2 infection through household contact and developed a maculopapular rash.
Two weeks later, pruritus was noted in the erythematous areas, and the papules were scaly and flattened. After two months, papules on the patient’s extremities, abdomen, and trunk changed to parchment-like plaques.
SARS-CoV-2 was confirmed by a positive immunofluorescence test. D-dimer values were high (1,876 ng/mL) and well above the positive cutoff (> 500 ng/mL). T-lymphotropic virus testing showed nonreactive serologies, and the chest radiograph was normal.
Histopathology showed cellular atypia and lymphocytic exocytosis, and immunohistochemistry revealed decreased CD7 T lymphocytes and elevated CD4 T lymphocytes, indicative of stage IB cutaneous T-cell lymphomas.
discoveries
The authors discussed the immunological dysregulation associated with SARS-CoV-2 infections that could increase the risk of IB cutaneous T-cell lymphomas such as Sézary syndrome and mycosis fungoides. Although environmental and infectious triggers for cutaneous T-cell lymphomas have not been well explored, theories of pathogenesis for mycosis fungoides and Sézary syndrome include regulation of helper T cells (Th) type 2 and the decrease of Th1 cells and the secretion of cytokines such as interferon α and interleukin-12.
COVID-19 has been associated with unbalanced cytokine production, down-regulation of regulatory T-lymphocyte activity, and elevated serum levels of D-dimer and C-reactive protein. In addition, SARS-CoV-2 infections are thought to increase the production of autoantibodies, exacerbating or triggering autoinflammatory and autoimmune diseases such as Kawasaki disease, Guillain-Barré syndrome, immune thrombocytopenic purpura, and possibly multiple sclerosis. systemic and lupus erythematosus.
Although controlled cutaneous T-cell lymphomas are not inherently a risk factor for COVID-19, aggressive cutaneous T-cell lymphomas, immunosuppressive therapy to treat these lymphomas, advanced patient age and lymphopenia may increase the risk of infection and the severity of COVID-19. -19.
Conclusions
In conclusion, this letter brought to light a case of relapsed cutaneous T-cell lymphoma after SARS-CoV-2 infection in a 60-year-old patient. The authors discussed the symptoms and immunological tests that confirmed COVID-19 and the recurrence of mycosis fungoides.
The letter mentioned the other autoimmune and autoinflammatory diseases known to have been triggered or exacerbated after COVID-19 in genetically predisposed individuals. The case highlighted the need to understand the immunogenetic dysregulation associated with SARS-CoV-2 infections to mitigate the potential recurrence of cutaneous T-cell lymphomas and other cancers in patients with controlled or indolent cancers.