concanavalin-a and Dermatitis--Exfoliative

The leukaemic form of cutaneous T-cell lymphoma, as represented by Sézary syndrome, exhibits erythroderma. We describe here an indolent leukaemic patient with cutaneous T-cell lymphoma, who initially had a nodulo-tumourous eruption with a crop of solid papules, but finally presented with papuloerythroderma. Histologically, the skin lesions showed non-epidermotropic dermal infiltration of atypical lymphocytes with lymphoid follicles and a granulomatous change. The circulating malignant CD4(+) CCR4(+) T cells lacked the expression of T-cell receptor and did not respond to concanavalin A. The unresponsiveness of T cells to the T-cell mitogen may be associated with the non-epidermotropic behaviour of the tumour cells and the initially non-erythrodermic eruption.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; CD3 Complex; CD4 Antigens; CD4-Positive T-Lymphocytes; Cells, Cultured; Concanavalin A; Dermatitis, Exfoliative; Flow Cytometry; Humans; Immunophenotyping; Lymphoma, T-Cell, Cutaneous; Male; Mitogens; Neoplastic Cells, Circulating; Phenotype; Receptors, Antigen, T-Cell; Receptors, CCR4; Skin Neoplasms; Treatment Outcome

A patient with Sézary syndrome developed a diffuse undifferentiated lymphoma of T-cell origin. After becoming resistant to multiple chemotherapeutic agents, the patient was treated with antithymocyte globulin. A 75% reduction in adenopathy and complete resolution of skin erythema was observed during an 8-day period. In addition the percent of circulating T cells and the ability of those cells to respond to phytohemagglutinin and concanavalin A were reduced after antithymocyte globulin therapy. The patient died of an intracerebral hemorrhage secondary to profound thrombocytopenia. The study suggests that tumor lysis may be achieved by passive antibody therapy in certain advanced lymphomas.

Topics: Antilymphocyte Serum; Concanavalin A; Dermatitis, Exfoliative; Humans; Immunotherapy; Keratoderma, Palmoplantar; Lectins; Lymphatic Diseases; Lymphocyte Activation; Lymphoma; Male; Middle Aged; Syndrome; T-Lymphocytes