Cutaneous T-cell lymphoma in a cardiac transplant recipient

Mycosis fungoides, an uncommon form of cutaneous T-cell lymphoma, arises in the skin and frequently progresses to generalized lymphadenopathy. Althoug h the cause of cutaneous T-cell lymphoma is unknown, chronic immunosuppress ion may play a role, A few cases have been reported in renal transplant rec ipients; however ours appears to be the Ist report of cutaneous T-cell lymp homa in a cardiac transplant recipient. In our patient, cutaneous manifesta tions of the disease were noted less than 1 year after transplantation. Sev en years after transplantation, Sezary syndrome, a variant form of mycosis fungoides, was diagnosed by tissue biopsy and flow cytometry analysis. Phot opheresis improved symptoms but was not well tolerated because of hemodynam ic sequelae. Psoralen and ultraviolet A therapy also improved the patient's skin condition, but a generalized lymphadenopathy developed. The maintenan ce immunosuppressive regimen was changed from cyclosporine (3 mg/kg/day) an d azathioprine to cyclosporine (1.5 mg/kg/day) and cyclophosphamide. Althou gh effective in the short-term, the results of this therapeutic strategy co uld not be fully evaluated because the patient died of acute myocardial inf arction.