[Primary cutaneous CD30+ T-cell lymphoproliferation during treatment with fingolimod: Case report and literature review]

E Cesbron; J-B Monfort; C Giannesini; P Duriez; P Moguelet; P Senet; C Francès; A Barbaud; F Chasset

doi:10.1016/j.annder.2018.02.010

[Primary cutaneous CD30+ T-cell lymphoproliferation during treatment with fingolimod: Case report and literature review]

Ann Dermatol Venereol. 2018 Jun-Jul;145(6-7):433-438. doi: 10.1016/j.annder.2018.02.010. Epub 2018 Apr 17.

[Article in French]

Authors

E Cesbron¹, J-B Monfort², C Giannesini³, P Duriez⁴, P Moguelet⁵, P Senet¹, C Francès¹, A Barbaud², F Chasset⁶

Affiliations

¹ Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
² Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 75013 Paris, France.
³ Service de neurologie, hôpital Saint-Antoine, 75012 Paris, France.
⁴ Service d'anatomopathologie, hôpital Saint-Antoine, 75012 Paris, France.
⁵ Service d'anatomopathologie, hôpital Tenon, AP-HP, 75020 Paris, France.
⁶ Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 75013 Paris, France. Electronic address: francois.chasset@aphp.fr.

PMID: 29673751
DOI: 10.1016/j.annder.2018.02.010

Abstract

Background: Fingolimod is an oral immunomodulator approved for relapsing-remitting multiple sclerosis. We report a case of a primary cutaneous CD30+ T-cell lymphoproliferation occurring 6 months after initiation of fingolimod. Based on a systematic literature review, the characteristics of these fingolimod-induced lymphoproliferative disorders are described.

Patients and methods: A 56-year-old woman developed cutaneous indurated and ulcerated nodular lesions 6 months after starting fingolimod for active relapsing-remitting multiple sclerosis. Histological examination of a punch biopsy sample demonstrated a polymorphous dermal infiltrate containing large atypical CD30+ cells, leading to diagnosis of primary cutaneous CD30+ anaplastic large-cell lymphoma. Chest-abdomen-pelvis CT scans were performed to rule out secondary cutaneous anaplastic large-cell lymphoma. Spontaneous clinical regression was observed and after assessing the benefit/risk ratio, it was decided to continue fingolimod under strict surveillance, with no relapse occurring by month 18.

Discussion: A systematic review of PUBMED/Medline and Embase identified seven other cases of lymphoproliferative disorders occurring during fingolimod treatment, including two other cases of primitive cutaneous CD30+ lymphoproliferative disorders.

Conclusion: Even if cutaneous CD30+ lymphoproliferative disorders occur only rarely during fingolimod treatment, dermatologists should nevertheless be aware of this association for which strict dermatological surveillance is required. We would also stress that these CD30+ lymphoproliferative disorders can disappear spontaneously, as in our case, even if treatment by fingolimod is continued.

Keywords: Fingolimod; Lymphome CD30+ anaplasique; Lymphoprolifération cutanée primitive CD30+; Primary cutaneous CD-30 positive cutaneous T-cell disorders; Relapsing-remitting multiple sclerosis; Sclérose en plaques.

Publication types

Case Reports
Review

MeSH terms

Female
Fingolimod Hydrochloride / adverse effects*
Humans
Ki-1 Antigen*
Lymphoproliferative Disorders / chemically induced*
Lymphoproliferative Disorders / immunology*
Middle Aged
T-Lymphocytes / immunology*

Substances

Ki-1 Antigen
Fingolimod Hydrochloride