Cytokine-producing lymphoma T cells in the skin and peripheral blood associated with atopy and hypereosinophilia

A 47 year old female with a history of hay fever and a family history of at opic eczema developed localized pruritic eczematous lesions over a three ye ar period. The lesions became generalized within just three months. Episode s of recurrent erythroderma followed and became resistant towards any thera py. Many immediate and some delayed hypersensitivity reactions were diagnos ed. In the peripheral blood, leukocytosis and hypereosinophilia were observ ed. In addition, levels of total IgE were highly increased in serum. Immuno phenotyping of the peripheral blood T cells revealed evidence for a clonal expansion of highly activated CD4(+) T cells with reduced CD2 and CD5 surfa ce expression. After a three-year course of severe disease,the diagnosis of a pleomorphic T cell lymphoma of the small-cell variant was established by histological examination and a polymerase-chain rection technique to deter mine the rearrangements of the gamma chain of the T cell receptor. Moreover , analysis of cytokine gene expression suggested that the high IgE concentr ations and eosinophil numbers observed in this patient were likely due to a n increased IL-5 and IL-13 production by lymphoma T cells.