Atypical presentation in Sézary syndrome with leonine face during flu syndrome by COVID-19
DOI:
https://doi.org/10.33448/rsd-v10i3.13768Keywords:
Leonine facies; Sézary; COVID-19.Abstract
Cutaneous T-cell lymphomas (LCCT) comprise a heterogeneous group of Non-Hodgkin's Lymphomas that commonly present as mycosis fungoides, of indolent course, and a leukemic form, with more aggressive evolution, known as Sézary syndrome. These neoplasms make the individual more susceptible to infections resulting from immunosuppression. In March 2020, the pandemic broke out due to the new coronavirus (COVID-19), which quickly spread and caused numerous deaths. The present study describes a case of difficult diagnosis represented erythematous-desquamative lesions in the trunk and limbs, associated with intense itching in course for eight months, conducted until then as pharmacoderma, which evolved during hospitalization, after viral infection by COVID-19 intra- hospital, with infiltration in the face, thinning of eyebrows and hair, disfiguring the patient, similar to the leonine face. The patient had a flu-like syndrome due to the new coronavirus, remaining in respiratory isolation for fourteen days, progressing without serious complications and then being referred to a specialized cancer service.
References
Bologna, J. L., Jorizzo, J. L., & Rapini, R. P. (2012). Dermatology. Elsevier, (3a ed.), 1867-1877.
Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., Wang, T., Zhang, X., Chen, H., Yu, H., Zhang, X., Zhang, M., Wu, S., Song, J., Chen, T., Han, M., Li, S., Luo, X., Zhao, J., & Ning, Q. (2020). Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 130(5):2620. 10.1172/JCI137244
Guan, W. J., Ni, Z. Y., Hu, Y. et al. (2020). Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 382: 1708 – 1720. 10.1056/NEJMoa2002032
Guitart, J., & Magro, C. (2007). Cutaneous T-cell lymphoid dyscrasia: a unifying term for idiopathic chronic dermatoses with persistent T-cell clones. Arch Dermatol. 143:921-932. 10.1001/archderm.143.7.921
Herman Hermann, B., Lehners, N., Brodhun, M. et al. (2017). Influenza virus infections in patients with malignancies – characteristics and outcome of the season 2014/15. A survey conducted by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO). Eur J Clin Microbiol Infect Dis. 36: 565– 573. 10.1007/s10096-016-2833-3
Johnson, W. T., Mukherji, R., Kartan, S., Nikbakht, N., Porcu, P., & Alpdogan, O. (2019). Allogeneic hematopoietic stem cell transplantation in advanced stage mycosis fungoides and Sezary syndrome: a concise review. Chin Clin Oncol. 8(1):12. 10.21037/cco.2018.10.03
Kubica, A. W., Davis, M. D., Weaver, A. L., Killian, J. M., & Pittelkow, M. R. (2012). Sézary syndrome: astudy of 176 patients at Mayo Clinic. J Am Acad Dermatol. 67(6):1189-1199. 10.1016/j.jaad.2012.04.043
Liang, W., Guan, W., Chen, R. et al (2020). Cancer patients in SARS‐CoV‐2 infection: a nationwide analysis in China. Lancet Oncol. 21: 335– 337. https://doi.org/10.1016/S1470-2045(20)30096-6
Molina, A., Zain, J., Arber, D.A. et al. (2005). Durable clinical, cytogenetic, and molecular remissions after allogeneic hematopoietic cell transplantation for refractory Sezary syndrome and mycosis fungoides. J Clin Oncol. 23(25):6163-6171. 10.1200/JCO.2005.02.774.
Nassem, S., Kashyap, R., Awasthi, N.P., Krishnani, N., & Kumari, N. (2009). Sézary syndrome presenting with ‘leonine facies’. Australas J Dermatol. 50(4):285-288. https://doi.org/10.1111/j.1440-0960.2009.00560
Olsen, E. A., Rook, A. H., Zic, J., Kim, Y., Porcu, P., Querfeld, C. et al. (2011). Sezary syndrome: immunopathogenesis, literature review of therapeutic options, and recommendations for therapy by the United States Cutaneous Lymphoma Consortium (USCLC). J Am Acad Dermatol 64(2):352–404. 10.1016/j.jaad.2010.08.037
Radford, P. T., Devesa, S. S., Anderson, W. F., & Toro, J. R. (2009). Cutaneous lymphoma incidence patterns in the United States: a population‐based study of 3884 cases. Blood. 113, 5064‐ 5073. 10.1182/blood-2008-10-184168
Sampaio, S., A. P., & Rivititi, E. A. (2008). Dermatologia. (3a ed.), Artes Médicas, 2008. 80: 1259-1262
Scarisbrick, J. J., Quaglino, P., Prince, H. M. et al. (2019). The PROCLIPI international registry of early‐stage mycosis fungoides identifies substantial diagnostic delay in most patients. Br J Dermatol. 181: 350– 357. 10.1111/bjd.17258.
Spicknall, K. E. (2018). Sézary syndrome: Clinical and histopathologic features, differential diagnosis, and treatment. Seminars in Cutaneous Medicine and Surgery. 37. 10.12788/j.sder.2018.005.
Sokolowska-Wojdylo, M., Wenzel, J., Gaffal, E. et al. (2005). Absence of CD26 expression on skin-homing LCD4+ T lymphocytes in peripheral blood is a highly sensitive marker for early diagnosis and therapeutic monitoring of patients with Sezary syndrome. Clin Exp Dermatol. 30:702-706. 10.1111/j.1365-2230.2005.01904.x.
Sun, W. H., Pabon, C., Alsayed, Y., Huang, P. P., Jandeska, S., Uddin, S. et al. (1998). Interferon-alpha resistance in a cutaneous T-cell lymphoma cell line is associated with lack of STAT1 expression. Blood. 91(2):570–6. https://pubmed.ncbi.nlm.nih.gov/9427711/
Talpur, R., Ward, S., Apisarnthanarax, N., Breuer-Mcham, J., & Duvic, M. (2002). Optimizing bexarotene therapy for cutaneous T-cell lymphoma. J Am Acad Dermatol. 47(5):672–84. 10.1067/mjd.2002.124607
Ueda, M., Martins, R., Hendrie, P. C. et al. (2020). Managing cancer care during the COVID19 pandemic: agility and collaboration toward a common goal. J Natl Compr Canc Netw; 18: 366– 369. 10.6004/jnccn.2020.7560
Von Lilienfeld‐Toal, M., Vehreschild, J. J., Cornely, O., Pagano, P., & Compagno FHirsch, H. H. (2020). European Hematology Association scientific working group infections in Hematology. Frequently asked questions regarding SARS‐CoV2 in cancer patients: Recommendations for clinicians caring for patients with malignant diseases 2020. https://www.nature.com/articles/s41375-020-0832-y
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J. et al. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama; 1–9. http://www.ncbi.nlm.nih.gov/pubmed/32031570
Watanabe, R., Teague, J. E., Fisher, D. C., Kupper, T. S., & Clark, R. A. (2014). Alemtuzumab therapy for leukemic cutaneous T-cell lymphoma: diffuse erythema as a positive predictor of complete remission. JAMA Dermatol; 150(7):776–9. 10.1001/jamadermatol.2013.10099.
Wilcox, R. A. (2017). Cutaneous T-cell lymphoma: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol. 92:1085-1102. 10.1002/ajh.24876
Willemze, R., Cerroni, L., Kempf, W. et al. (2019). The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood. 133 (16):1703-1714. 10.1182/blood-2018-11-881268
Yamashita, T., Marques, M. E. A., Abbade, L. P. F., & Marques, S. A. (2012). Micose fungoide e síndrome de Sézary: revisão e atualização clínica, histopatológica e imuno-histoquímica - Anais Brasileiros de Dermatologia, https://www.scielo.br/scielo.php?pid= S036505962012000600001&script=sci_abstract&tlng=pt
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Antonio Igor Taumaturgo Dias Soares; Carol Anne da Silva Fernandes; Mariana Guimarães Pereira; Kristopherson Lustosa Augusto; Igor Santos Costa
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
