RESUMEN
Primary cutaneous CD8 positive aggressive epidermotropic cytotoxic T-cell lymphoma (PCAT) is a rare and heterogeneous entity with less than 100 published cases to date. A 68-year-old man was following up for an inflammatory lichen-lupus overlap dermatosis of 3 years duration. Treatment with methotrexate was started, observing a dramatic change in the skin lesions that became infiltrated plaques and generalized ulcerated tumours distributed over trunk and extremities. Histological study showed marked epidermotropism of CD8 positive cells and monoclonality was demonstrated by the polymerase chain reaction. Diagnosis of PCAT was concluded. Treatment with polychemotherapy was indicated. The PCAT is characterized by a rapid clinical history of generalized papules, plaques, nodules and tumours with frequent ulceration and necrosis. Although it has no pathognomonic clinical features, there are clinical, histological and prognostic data that define them as a group and differentiate them from other lymphomas. Exceptionally, there are cases reported which have been triggered following treatment with immunosuppressive drugs. In our patient we think that PCAT was triggered by the transformation of a pre-existing dermatosis, which had never showed a lymphoproliferative profile in biopsies before. A possible pathogenic mechanism is that in some inflammatory dermatoses, chronic antigenic stimulation in a situation of iatrogenic immunosuppression may favour the development of a malignant clonal T cell.
RESUMEN
BACKGROUND: Etoricoxib is a selective inhibitor of cyclooxygenase 2 used mainly to treat osteoarticular pain. Here, we report the case of a patient who developed acute kidney failure and immune hemolytic anemia after the use of etoricoxib. STUDY DESIGN AND METHODS: An 83-year-old female patient developed immune hemolytic anemia and acute kidney failure after treatment with etoricoxib for articular pain. Given the acute kidney failure, she required five hemodialysis sessions. She was discharged after 17 days. The case of immune hemolytic anemia and kidney failure was fully resolved. RESULTS: The direct antiglobulin test was not only positive for IgG but also for C3b and C3d, showing a very intense reactivity (++++). The eluate's reactivity was weaker (++) and showed no defined specificity. The investigation of unexpected antibodies in the serum of the patient showed a reactivity pattern similar to the eluate's: weak reactivity without specificity. The serum of the patient was compared to urine and plasma samples of two groups of volunteers. The indirect antiglobulin test showed only a very strong reactivity with the urine samples of the volunteers who had received etoricoxib. DISCUSSION: Considering that positive eluate is not the typical serologic profile of drug-induced immune hemolytic anemia, developing in-house techniques to show the causal link between them may be of interest to guide the treatment and avoid the empirical use of drugs. CONCLUSION: Etoricoxib must be considered as a possible cause of acute kidney failure in cases of immune hemolytic anemia.