METASTATIC SQUAMOUS-CELL CARCINOMA IN A P ATIENT WITH IDIOPATHIC CD4-LYMPHOCYTOPENIA( T)

Introduction. Skin cancers are more frequent and more aggressive in im munosuppressed patients. Case report. A 58-year-old man was seen in Ja nuary 1994 for squamous cell carcinoma of the right shoulder which had grown to 7 x 7 cm in the last 5 months. The patient had a past histor y of surgical exeresis of 5 squamous cell carcinomas and 3 basal cell carcinomas. Despite complete exeresis, the disease spread to localized then diffuse skin metastases. Acitretine and alpha-interferon were un effective. Polychemotherapy stabilized the situation but several bronc hopulmonary infections with atypical germs led to death (in February 1 995). The patient had CD4 lymphocytopenia with a count < 100/mm(3) in January 1994 of unknown origin (viral infection was eliminated). Discu ssion. Our patient had idiopathic CD4 lymphocytopenia. In 40 p. 100 of the cases CD4 lymphocytopenia is caused by AIDS and in 53 p. 100 by o ther diseases, especially skin diseases including Kaposi syndrome, myc osis fungoides, squamous cell or basal cell carcinoma. The cutaneous c arcinomas which often develop in AIDS patients with low CD4 counts are usually less aggressive than in our patient. Certain neoplasia could be the cause of the lymphopenia. CD4 counts are usually more variable and lymphopenia of shorter duration in other etiologies.