Subcutaneous panniculitic-like T-cell lymphoma localized to a site of peginterferon alfa-2a administration

Abstract

T cell dyscrasias that demonstrate a proclivity for the subcutaneous fat include atypical lymphocytic lobular panniculitis, lupus profundus, and primary subcutaneous T cell lymphoma, including subcutaneous panniculitis-like T cell lymphoma (SPTCL). We encountered two patients who developed fever and indurated abdominal erythema at their peginterferon alfa-2a injection sites. Biopsies showed an atypical CD8 positive, granzyme positive, CD5 negative, MXA negative lymphocytic lobular panniculitis, diagnostic of SPTCL. Peginterferon alfa-2a was held in both patients. One patient received chemotherapy with an excellent response, while the other continued to have progressive disease. Peginterferon alfa-2a is known to significantly elevate serum MXA, which may induce high levels of MXA expression at the injection site, creating a microenvironment for the development of lupus profundus, which may eventuate into SPTCL. In summation, a potential risk of peginterferon alfa-2a injections is the development of SPTCL potentially arising in a background of an exogenous interferon triggered lymphocytic panniculitis.

Keywords:

• Subcutaneous T cell lymphoma
• peginterferon
• lupus profundus
• MXA
• T cell dyscrasia

Acknowledgements

The authors would like to thank Dr. Thomas Fahey, Dr. Ellen Ritchie, Dr. Justin Kaner, Dr. Brendan Finnerty, Dr. Jia Ruan, Dr. Michael Seth Samuel, Dr. Sarah Rutherford, and Dr. Michal Bar-Natan, and all additional members of the clinical care teams for their valuable input in this case series.

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Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.