Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-29T02:32:49.210Z Has data issue: false hasContentIssue false
  • English
  • Français

Lymphoproliferative disorder of nasopharynx after long-standing cyclosporin therapy for psoriatic arthritis

Published online by Cambridge University Press:  07 April 2010

A C Leong ,
J Yong  and
N Salama
A C Leong*
Affiliation:
Department of Otolaryngology, University Hospital Lewisham, London, UK
J Yong
Affiliation:
Department of Otolaryngology, University Hospital Lewisham, London, UK
N Salama
Affiliation:
Department of Otolaryngology, University Hospital Lewisham, London, UK
*
Address for correspondence: Ms AC Leong, Department of Otolaryngology, University Hospital Lewisham, London SE13 6LH, UK. Fax: +44 (0)20 8333 3192 E-mail: ackleong@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The increased risk of developing lymphoproliferative disorders, mainly linked with Epstein–Barr virus infection, is well documented in patients with cyclosporin-induced immunosuppression following organ transplantation. Lymphoproliferative disease is extremely rare in the non-transplant setting.

Methods:

We present the first published case of non-Epstein–Barr virus associated lymphoproliferative disease in a patient receiving long-standing cyclosporin therapy for psoriatic arthritis, which presented as a recurrent nasopharyngeal mass.

Results:

Histological examination showed lymphoid hyperplasia in repeated biopsies. Macroscopic clearance was persistently followed by aggressive recurrence. Spontaneous regression occurred upon cyclosporin withdrawal.

Conclusion:

This rare complication of cyclosporin therapy in non-transplant patients is highlighted from an otolaryngological perspective, as the sole presentation may be a recurrent nasopharyngeal mass. Repeated biopsies showing lymphoid hyperplasia, together with aggressive recurrence, should prompt immediate drug withdrawal to reduce immunosuppression and promote spontaneous regression.

Keywords

Lymphoproliferative DisorderNasopharynxPsoriasisCyclosporin
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 10 , October 2010 , pp. 1120 - 1122
Copyright
Copyright © JLO (1984) Limited 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Krupp, P, Monka, C. Side-effect profile of cyclosporin A in patients treated with psoriasis. Br J Derm 1990;122(suppl 36):47–56CrossRefGoogle Scholar
2Starzl, TE, Nalesnik, MA, Porter, KA, Ho, M, Iwatsuki, S, Griffith, BP et al. Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet 1984;i:583–7CrossRefGoogle Scholar
3Tao, J, Wasik, MA. Epstein-Barr virus associated polymorphic lymphoproliferative disorders occurring in nontransplant settings. Lab Invest 2001;81:429–37CrossRefGoogle ScholarPubMed
4Leblond, V, Sutton, L, Dorent, R, Davi, F, Bitker, MO, Gabarre, J et al. Lymphoproliferative disorders after organ transplantation: a report of 24 cases observed in a single center. J Clin Oncol 1995;13:961–8CrossRefGoogle ScholarPubMed
5Herrman, BW, Sweet, SC, Hayashi, RJ, Canter, CE, White, FV, Lieu, JE et al. Otolaryngological manifestations of posttransplant lymphoproliferative disorder in pedatric thoracic transplant patients. Int J Ped Otorhinol 2006;70:303–10CrossRefGoogle Scholar
6Kamel, OW, Van de Rijn, M, Weiss, LM, Del Zoppo, GJ, Hench, PK, Robbins, BA et al. Reversible lymphomas associated with Epstein-Barr virus occurrence during methotrexate therapy for rheumatoid arthritis and dermatomyositis. N Engl J Med 1993;328:1317–21CrossRefGoogle Scholar
7Fozza, C, Dore, F, Bonfigli, S, Podda, L, Longinotti, M. Two cases of chronic lymphoproliferative disorders in psoriatic patients treated with cyclosporin: hairy cell leukaemia and Waldenstrom macroglobulinaemia. Eur J Dermatol 2005;15:271–3Google Scholar
8Lelievre, JD, Sacre, K, Adle-Biassette, H, Molinier-Frenkel, V, Gaulard, P, Papo, T. Epstein-Barr virus-associated lymphoproliferative disease after longstanding cyclosporin therapy for psoriasis: a case of spontaneous regression. J Am Acad Dermatol 2005;52:S24–7CrossRefGoogle ScholarPubMed