Atypical presentation in Sézary syndrome with leonine face during flu syndrome by COVID-19




Leonine facies; Sézary; COVID-19.


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.


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.

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.

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.

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.

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.

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, S036505962012000600001&script=sci_abstract&tlng=pt



How to Cite

SOARES, A. I. T. D. .; FERNANDES, C. A. da S. .; PEREIRA, M. G. .; AUGUSTO, K. L. .; COSTA, I. S. . Atypical presentation in Sézary syndrome with leonine face during flu syndrome by COVID-19. Research, Society and Development, [S. l.], v. 10, n. 3, p. e58510313768, 2021. DOI: 10.33448/rsd-v10i3.13768. Disponível em: Acesso em: 16 apr. 2021.



Health Sciences