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De novo manifestation of Mycosis fungoides shortly after COVID-19

Article in Medical Review · January 2024

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5 authors, including:

Georgi Tchernev Simona Kordeva

Medical Institute of the Ministry of the Interior, Sofia Onkoderma
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Valentina Broshtilova José Cardoso

Military Medical Academy Hospitais da Universidade de Coimbra
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Onkoderma – Clinic for Dermatology, Venereology and Dermatologic Surgery – Sofia
1

Department of Dermatology and Venereology, Medical Institute of Ministry of Interior – Sofia

2

3
Department of Dermatology and Venereology, Military Medical Academy – Sofia
4
Department of Dermatology and Venereology, University Hospital of Coimbra – Coimbra, Portugal

&RUUHVSRQGLQJDXWKRU A 57-year-old male presented to the dermatology

Prof. Georgi Tchernev, MD department with primary complaints of erythematous-
Onkoderma – Policlinic for Dermatology, edematous plaques located on both axillary regions,
Venereology and Dermatologic Surgery in the creases of the thighs and the upper part of both
26 General Skobelev blvd. feet. The patient noticed the development of the rash
Bg – 1606 Sofia
3.5-4 months after a COVID-19 infection (September
e-mail: georgi_tchernev@yahoo.de
2021). Otherwise, he was vaccinated with AZD1222
Phone: 00359885588424
(ChAdOx1) in February and April 2021.
The dermatological examination showed erythema-
tous-edematous plaques sharply limited by the surrounding
skin with partially polycyclic form in the axillary region,
thighs proximally, inguinal folds, and the upper and lateral
parts of both feet (Fig. 1).
A biopsy was taken from a lesional skin (Fig. 2).
Histology showed ortho- and follicular hyperkeratosis,
horizontally alternating with parakeratosis, uniform
acanthosis with elongation of the distal parts of the
epidermal ridges, pronounced epidermotropism of lym-
phoid cells with large cerebriform nuclei and light cyto-
plasms forming variegated nests in the middle epidermal
segment, sparse mainly perivascular goblet cell inflam-
matory infiltrate in upper dermis. Immunohistochemical
staining with CD30 was negative. The histological pic-
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The immunohistochemistry showed tumor cells ex-
pressing CD3, CD5 and CD8 in ratio of CD4/CD8 = 1:2.
Whole-body CT was done which resulted in: no
evidence of lymphadenomegaly, bone marrow biopsy –
the immunohistochemical finding pointed to mildly ex-
pressed reactive bone marrow changes without evidence
of lymphocytic involvement.
.H\ ZRUGV: Mycosis fungoides, cutaneous T cell lymphoma,
The imaging flow cytometry did not detect an in-
COVID-19, vaccination creased percentage of lymphocytes with aberrant ab-
sence of T cell antigens CD7, CD26. Atypical CD4+
7KHUHLVQRFRQIOLFWRILQWHUHVW1RILQDQFLDOGLVFORVXUH lymphocytes, CD26 – 0.162/L.
  ɆȿȾɂɐɂɇɋɄɂɉɊȿȽɅȿȾ460 1

The scientific data can be quite

contradictory [4]. There are even de-
scribed cases of complete remission
of MF after passing COVID-19 [4].
Partial remission of Sézary syn-
drome has also been observed after
previous COVID-19 infection [5].
Interesting information regard-
ing the spontaneous regression of the
organ manifestations can be found
in a patient with primary cutaneous
anaplastic large cell lymphoma after
SARS-CoV-2 vaccination [6].
)LJ  (U\WKHPDWRXVHGHPDWRXV SODTXHV VKDUSO\ OLPLWHG E\ WKH VXUURXQGLQJ VNLQ ZLWK D At the moment, the data in the
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WKHXSSHUDQGODWHUDOSDUWRIERWKIHHW HI
literature associates a previous COV-
ID-19 infection/vaccination with the
de novo manifestation of a heteroge-
neous tumor type like lymphomas or
melanoma [1, 2, 7].
We report an interesting case of
a patient who developed a cutaneous
form of T cell lymphoma shortly after
COVID-19 infection. Taking into ac-
)LJ  %LRSV\ WDNHQ IURP DQ HU\WKHPDWRXVHGHPDWRXV SODTXH D 0\FRVLV IXQJRLGHV +( count the currently available limited
[  ± RUWKR DQG IROOLFXODU K\SHUNHUDWRVLV KRUL]RQWDOO\ DOWHUQDWLQJ ZLWK SDUDNHUDWRVLV
XQLIRUPDFDQWKRVLVZLWKHORQJDWLRQRIWKHGLVWDOSDUWVRIWKHHSLGHUPDOULGJHVVSDUVHPDLQO\ and at the same time contradictory lit-
SHULYDVFXODUURXQGFHOOLQIODPPDWRU\LQILOWUDWHLQWKHXSSHUGHUPLVE0\FRVLVIXQJRLGHV erature data on the subject, it is likely
+([±SURQRXQFHGHSLGHUPRWURSLVPRIO\PSKRLGFHOOVZLWKODUJHFHUHEULIRUPQXFOHLDQG that the pathogenetic significance of
EULJKWF\WRSODVPVIRUPLQJQHVWVRIYDULRXVFDOLEHUVLQWKHPLGGOHHSLGHUPDOVHJPHQWVSDUVH
PDLQO\SHULYDVFXODUURXQGFHOOLQIODPPDWRU\LQILOWUDWHLQXSSHUGHUPLVF0)[&'[±
this type of disruption of cellular in-
LPPXQRKLVWRFKHPLFDOVWDLQLQJZLWK&'LVQHJDWLYH tegrity/tissue homeostasis (incorpora-
tion of viral proteins) should be fur-
A systemic treatment with Methotrexate sodium was ther analyzed and studied at a higher number of patients in
recommended according to a scheme of 20 mg/week or order to make a definitive conclusion.
2.5 mg administrated in four tablets in the morning and
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four tablets in the evening – six days a week, folic acid
1. /L +2 /LSVRQ - 1HZ P\FRVLV IXQJRLGHVOLNH O\PSKRPDWRLG
once daily in the morning (on days when Methotrexate reaction following COVID-19 vaccination: A case report. SAGE
sodium is not taken) and topical Clobetasol propionate Open Med Case Rep. 2022 Oct 15;10:2050313X221131859. doi:
10.1177/2050313X221131859.
cream two times daily. The treatment resulted in a good 2. Oliveira ÉVL, Landell LM, Souza CDS. Recurrence of controlled
initial response. mycosis fungoides after SARS-CoV-2 infection. An Bras
The side effects from COVID-19 or those mani- Dermatol. 2022 Oct 12:S0365-0596(22)00225-2. doi: 10.1016/j.
abd.2022.06.001. Epub ahead of print.
fested after vaccination for COVID-19 can vary. Cases 3. Ehrenfeld M, Tincani A, Andreoli L, et al. Covid-19 and
of recurrence of MF after previous vaccination or after autoimmunity. Autoimmun Rev. 2020 Aug;19(8):102597. doi:
COVID-19 infection have been described in the world 10.1016/j.autrev.2020.102597. Epub 2020 Jun 11.
4. 2KDGL/+RVVHLQ]DGHK)'DGNKDKIDU61DVLUL62QFRO\WLFH൵HFW
literature [1, 2]. Molecular or antigen mimicry, due to of SARS-CoV-2 in a patient with mycosis fungoides: A case report.
the similarity of certain viral proteins and similar to Clin Case Rep. 2022 Apr 4;10(4):e05682. doi: 10.1002/ccr3.5682.
analogous structures in the human organism, is also one 5. 6QRZGHQ&1J6&KRL-3DUWLDOUHPLVVLRQRIDGYDQFHGXQWUHDWHG
Sézary syndrome after COVID-19. JAAD Case Rep. 2022
of the possible theoretical pathogenetic explanations for Mar;21:165-168. doi: 10.1016/j.jdcr.2021.12.005. Epub 2022 Jan 6.
the reactivation or de novo manifestation of MF, but also 6. *DPELFKOHU7%RPV6+HVVDP6HWDO3ULPDU\FXWDQHRXVDQDSODဧLF
of other autoimmune diseases such as Guillain-Barré large-cell lymphoma with marked spontaneous regression of organ
PDQLIHဧDWLRQ DIWHU 6$56&R9 YDFFLQDWLRQ %U - 'HUPDWRO 
syndrome, Kawasaki disease, immune thrombocyto- Dec;185(6):1259-1262. doi: 10.1111/bjd.20630. Epub 2021 Oct 3.
penic purpura, antiphospholipid antibodies, thrombosis 7. Leis AA, Montesi AP, Khan SM, Montesi M. Case Report: Malignant
Melanoma Associated With COVID-19: A Coincidence or a Clue?
and, potentially, lupus erythematosus, systemic sclero-
Front Med (Lausanne). 2022 May 26;9:845558. doi: 10.3389/
sis, and pemphigus vulgaris [3]. fmed.2022.845558.

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