RESUMO
OBJECTIVE: To determine, in patients with mycosis fungoides and Sézary syndrome, the incidence of infections, the importance of nosocomial infections, and the epidemiologic factors associated with cutaneous and visceral infections. DESIGN AND SETTING: Retrospective inception cohort study at a university medical center referral clinic. PATIENTS: Three hundred fifty-six patients with mycosis fungoides or Sézary syndrome. MAIN OUTCOME MEASURES: Incidence rates for specific infections, and multivariate risk ratios for demographic and clinical factors associated with infection. RESULTS: Cutaneous bacterial infection was most common (17.0 infections per 100 patient-years), followed by cutaneous herpes simplex virus and herpes zoster virus infection (3.8 infections per 100 patient-years), bacteremia (2.1 infections per 100 patient-years), bacterial pneumonia (1.7 infections per 100 patient-years), and urinary tract infection (1.4 infections per 100 patient-years). Twenty-seven percent of herpesvirus infections disseminated on the skin but none disseminated to internal organs. Pneumonia or bacteremia was present in 88% of patients who died of infection. Only three patients had invasive fungal or protozoal infection. Nosocomial infections accounted for 19% of cutaneous bacterial infections, 59% of bacteremias, 62% of pneumonias, and 88% of infections leading to death. By logistic and Cox regression, the presence of extracutaneous involvement with lymphoma was the most important independent risk factor for recurrent bacterial skin infection (risk ratio [RR], 12; 95% confidence interval [CI], 1.2 to 120), disseminated herpesvirus infection (RR, 28; 95% CI, 2.7 to 290), bloodstream infection (RR, 5.5; 95% CI, 1.7 to 18), and death from infection (RR, 15; 95% CI, 3.6 to 64). CONCLUSIONS: Community-acquired bacterial skin infections are a common cause of morbidity in patients with mycosis fungoides and Sézary syndrome but are usually treated without hospital admission. Bacteremia and pneumonia, which are usually nosocomial, are the major infectious causes of death. Advanced disease stage, independent of corticosteroids and other therapies, is the most important risk factor for both cutaneous and systemic infections.
Assuntos
Infecções Bacterianas/etiologia , Micose Fungoide/complicações , Síndrome de Sézary/complicações , Dermatopatias Infecciosas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/epidemiologia , Estudos de Coortes , Infecção Hospitalar/complicações , Dermatomicoses/epidemiologia , Dermatomicoses/etiologia , Feminino , Herpes Simples/epidemiologia , Herpes Simples/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Dermatopatias Infecciosas/epidemiologiaRESUMO
Cutaneous multilobated T-cell lymphoma is an uncommon variant of skin-based peripheral T-cell lymphoma typically characterized by cutaneous nodules in elderly patients and a chronic clinical course. We report a case of the disease that led to the patient's death within 2 years after onset. This disease may be associated with a more aggressive clinical course than generally recognized.
Assuntos
Linfoma Cutâneo de Células T , Neoplasias Cutâneas , Idoso , Núcleo Celular/ultraestrutura , Humanos , Perna (Membro) , Metástase Linfática , Linfoma Cutâneo de Células T/patologia , Linfoma Cutâneo de Células T/ultraestrutura , Masculino , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/ultraestruturaRESUMO
Complete responses lasting from 4 to 14 years were documented in 65 of 331 (20%) patients with cutaneous T cell lymphoma treated with topical mechlorethamine (HN2) between 1968 and 1982. Such long-lasting remissions occurred most often, but not invariably, in patients with patch or plaque phase mycosis fungoides without palpable lymphadenopathy (stage Ia or Ib). The likelihood of a continuous remission was enhanced by initiation of treatment before an unequivocal pathologic diagnosis. Despite the long-lasting responses in these patients, however, relapses have been documented in 11 (17%) of these patients, and all relapses occurred within 8 years of discontinuing maintenance topical chemotherapy. Thus, in our experience, a continuous remission lasting 8 or more years provides evidence that cutaneous T cell lymphoma can be eradicated by aggressive topical chemotherapy. This circumstance was observed in 35 patients, representing a cure rate of at least 11% overall. In addition, when compared with the general population of the United States, patients who received topical HN2 were at an 8.6-fold and a 1.8-fold increased risk for the development of squamous cell carcinoma and enhanced for Hodgkin's disease and colon cancer but not for systemic cancers known to be induced by systemic administration of alkylating drugs. These results compare favorably with experiences with topical HN2 chemotherapy at other centers but raise questions about the risks associated with long-term administration for maintenance of remissions.
Assuntos
Linfoma/tratamento farmacológico , Mecloretamina/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Linfoma/diagnóstico , Masculino , Mecloretamina/administração & dosagem , Mecloretamina/efeitos adversos , Pessoa de Meia-Idade , Micose Fungoide/tratamento farmacológico , Neoplasias/induzido quimicamente , Recidiva , Indução de Remissão , Síndrome de Sézary/tratamento farmacológico , Neoplasias Cutâneas/diagnóstico , Linfócitos T , Tumor de Wilms/secundárioRESUMO
To determine whether the human T-cell lymphoma-leukemia virus (HTLV) is associated with particular cancers, patient sera were surveyed for HTLV-specific antibodies. An association was seen with aggressive cancers of mature T-cells, specifically Japanese adult T-cell leukemia (ATL) and T-cell lymphosarcoma cell leukemia (TLCL), a similar cancer of Caribbean blacks. Ninety to 100% of these patients possessed HTLV-specific antibody. Forty-seven and 20% of relatives of ATL and TLCL patients, respectively, and 12 and 4% of healthy donors from ATL and TLCL endemic areas were also antibody positive. Visceral organ involvement, hypercalcemia, and skin manifestation, features of ATL and TLCL, were often seen in other antibody-positive patients. Childhood cancers, most cutaneous T-cell and all non-T-cell leukemias and lymphomas, myeloid leukemias, Hodgkin's disease, and solid tumors were not associated with HTLV. Healthy United States donors and European patients with non-malignant diseases were antibody negative. HTLV is thus associated with a subtype of adult T-cell leukemia-lymphoma, clustered in viral endemic areas, with apparent racial and geographic predilection.