Cutaneous T-cell lymphoma and human immunodeficiency virus infection: 2 cases and a review of the literature

Cutaneous non-Hodgkin's lymphomas are rare in patients with HIV-1 infection and almost all of the cases reported are of T-cell lineage with histopatho logical features of mycosis fungoides or Sezary syndrome. We studied 2 case s of mycosis fungoides in HIV-1-positive patients who were intravenous drug abusers and were in stage II and IV C2 (CDC'86), respectively. The first p atient (stage II) had multiple, erythematous and infiltrated large plaques on the abdomen, back, arms and legs, whereas the second patient (stage IV) had smaller erythematous, slightly scaly and infiltrated pruritic plaques o n the trunk and limbs. Their CD4 lymphocyte counts were 634 and 250 cells/m m(3), respectively, Biopsies showed features consistent with mycosis fungoi des, with an epidermotropic pattern. The immunohistochemical study revealed a T-cell lineage of this atypical infiltrate. Both patients partially resp onded to topical steroid ointment, showing moderate improvement, Further bi opsies performed 6 months later confirmed the prior diagnosis of mycosis fu ngoides, No tumour stage was observed during a 2-year follow-up. We conclud e that mycosis fungoides is rare in HIV-positive patients, but must be incl uded in the differential diagnosis of erythematous plaques in these patient s, In suspected, but non-diagnostic cases of mycosis fungoides in HIV-posit ive patients, only a close clinical and histopathological follow-up can con firm the diagnosis.