Cutaneous T-cell Lymphoma and Human Immunode ¢ ciency 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 histopathological features of mycosis fungoides or Sezary syndrome. We studied 2 cases 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 ¢rst patient (stage II) had multiple, erythematous and in¢ltrated large plaques on the abdomen, back, arms and legs, whereas the second patient (stage IV) had smaller erythematous, slightly scaly and in¢ltrated pruritic plaques on the trunk and limbs. Their CD4 lymphocyte counts were 634 and 250 cells/mm3, respectively. Biopsies showed features consistent with mycosis fungoides, with an epidermotropic pattern. The immunohistochemical study revealed a Tcell lineage of this atypical in¢ltrate. Both patients partially responded to topical steroid ointment, showing moderate improvement. Further biopsies performed 6 months later con¢rmed the prior diagnosis of mycosis fungoides. No tumour stage was observed during a 2-year follow-up. We conclude that mycosis fungoides is rare in HIV-positive patients, but must be included in the di¡erential diagnosis of erythematous plaques in these patients. In suspected, but non-diagnostic cases of mycosis fungoides in HIV-positive patients, only a close clinical and histopathological follow-up can con¢rm the diagnosis.