Peripheral blood abnormality in Sezary Syndrome with bacteremia

Wizar Putri Mellaratna; Zubir; Juwita  Sahputri; Irwandi

doi:10.15562/bmj.v11i3.3675

Peripheral blood abnormality in Sezary Syndrome with bacteremia

Wizar Putri Mellaratna ,

Zubir ,

Juwita Sahputri ,

Irwandi ,

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DOI: https://doi.org/10.15562/bmj.v11i3.3675 |
Published: 2022-11-28

Abstract

Introduction: Sezary syndrome defined as a set of symptoms consist of erythroderma, generalized lymphadenopathy, and Sezary cells were detected in peripheral blood, skin and lymph nodes.

Case: Patients with chief complaints red and scaly patches cover almost part of the body accompanied by itching since 1 week ago. The patient had history of taking herbal medicines 2 weeks earlier. There is an erosion and crusting at inferior lips. There is also fissure at left side ventral hand region. There is no generalized lymphadenopathy. The patient has fever, hypertension and hyperglycemia. The laboratory result showed leukocytosis with Sezary cells > 1000 cells/mm³, and bacteremia (coccus). Differential diagnosis of patients was Sezary syndrome, drug-induced erythroderma and mycosis fungoides. The diagnosis was Sezary syndrome because erythroderma and Sezary cells > 1000 cells/ mm³were found. The patient was treated with injection of corticosteroid, antibiotic, barrier repair moisturizer and potent topical corticosteroid.

Conclusion: Sezary syndrome is often accompanied by bacteremia due to impaired skin barrier function and decreased cellular immunity. Examination of biopsy, bacterial culture and flow cytometer is required for diagnosis.

References

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LeBoit P, Pincus L. Mycosis Fungoides and Sezary Syndrome. In: ES, Jaffe, editors. Hematopatholgy. 2017. p. 713–29.
Murphy E, Bruhn R. H=Human T-cell leukemia viruses (HTLV-1, HTLV-2). In: Bennet J, Dolin R, Blaser M, editors. Principles and Practice of Infectious Disease. 9th ed. p. 2185–201.
Bagot M, Stadler R. Cutaneous Lymphoma. In: Kang S, Amagai M, Bruckner A, Enk A, Margolis D, McMichael A, editors. Fitzpatrick’s Dermatology. 9th ed. New York: Mc Graw Hill; 2019.
Hristov A, Tejasvi T, Wilcox R. Mycosis fungoides and Sezary syndrome: 2019 update on diagnosis, risk-stratification and management. Am J Hematol. 2019;94:1027–41.
Sommer L, Reboli A, Heymann W. Bacterial disease. In: Jean B, editor. Dermatology. 4th ed. 2018. p. 1259–95.
Henn A, Michel L, Fite C, Deschamps L, Ortonne N, et al. Sezary syndrome without erythroderma. 2014;72(6):1003–9.
Gatti M, Ippoliti I, Poluzzi E, Antonazzo I, Moro P, Moretti U. Assessment of adverse reactions to α-lipoic acid containing dietary supplements through spontaneous reporting systems. Clin Nutr. 2021;40(3):1176–85.
Zhu WF, Fang DR, Fang H. Drug-induced erythroderma in patients with acquired immunodeficiency syndrome. World J Emerg Med. 2021;12(4):299–302.
Jahan-Tigh RR, Huen AO, Lee GL, Pozadzides J V., Liu P, Duvic M. Hydrochlorothiazide and cutaneous T cell lymphoma: Prospective analysis and case series. Cancer. 2013;119(4):825–31.
Pai RK, Mullins FM, Kim YH, Kong CS. Cytologic evaluation of lymphadenopathy associated with mycosis fungoides and Sezary syndrome. Cancer. 2008;114(5):323–32.
Inamadar AC, Ragunatha S. The rash that becomes an erythroderma. Clin Dermatol. 2019;37(2):88–98.
Goodlad J, Calonje E. Cutaneous lymphoproliferative disease and related disorders. In: Calonje E. McKee’s pathology of the skin. Fifth edition. 2020. 1403–1519 p.
Murray M. Diabetes Mellitus types I and II. In: Pizzorno JE. Textbook of natural medicine. Fifth edition. 2021. 1262 p.
Durgin JS, Weiner DM, Wysocka M, Rook AH. The immunopathogenesis and immunotherapy of cutaneous T cell lymphoma: Pathways and targets for immune restoration and tumor eradication. J Am Acad Dermatol. 2021;84(3):587–95.
Nguyen C V., Bohjanen KA. Skin-Directed Therapies in Cutaneous T-Cell Lymphoma. Dermatol Clin [Internet]. 2015;33(4):683–96. Available from: http://dx.doi.org/10.1016/j.det.2015.05.004
Spicknall K. Sézary syndrome-clinical and histopathologic features, differential diagnosis, and treatment. Semin Cutan Med Surg. 2018;37(1):18–23.
Serrano L, Martinez-Escala ME, Zhou XA, Guitart J. Pruritus in Cutaneous T-Cell Lymphoma and Its Management. Dermatol Clin. 2018;36(3):245–58.

[1] Willemze R. Cutaneous T Cell Lymphoma. In: Bolognia J, Schaffer J, Cerroni L, editors. Dermatology. 2018. p. 2127–47.

[2] LeBoit P, Pincus L. Mycosis Fungoides and Sezary Syndrome. In: ES, Jaffe, editors. Hematopatholgy. 2017. p. 713–29.

[3] Murphy E, Bruhn R. H=Human T-cell leukemia viruses (HTLV-1, HTLV-2). In: Bennet J, Dolin R, Blaser M, editors. Principles and Practice of Infectious Disease. 9th ed. p. 2185–201.

[4] Bagot M, Stadler R. Cutaneous Lymphoma. In: Kang S, Amagai M, Bruckner A, Enk A, Margolis D, McMichael A, editors. Fitzpatrick’s Dermatology. 9th ed. New York: Mc Graw Hill; 2019.

[5] Hristov A, Tejasvi T, Wilcox R. Mycosis fungoides and Sezary syndrome: 2019 update on diagnosis, risk-stratification and management. Am J Hematol. 2019;94:1027–41.

[6] Sommer L, Reboli A, Heymann W. Bacterial disease. In: Jean B, editor. Dermatology. 4th ed. 2018. p. 1259–95.

[7] Henn A, Michel L, Fite C, Deschamps L, Ortonne N, et al. Sezary syndrome without erythroderma. 2014;72(6):1003–9.

[8] Gatti M, Ippoliti I, Poluzzi E, Antonazzo I, Moro P, Moretti U. Assessment of adverse reactions to α-lipoic acid containing dietary supplements through spontaneous reporting systems. Clin Nutr. 2021;40(3):1176–85.

[9] Zhu WF, Fang DR, Fang H. Drug-induced erythroderma in patients with acquired immunodeficiency syndrome. World J Emerg Med. 2021;12(4):299–302.

[10] Jahan-Tigh RR, Huen AO, Lee GL, Pozadzides J V., Liu P, Duvic M. Hydrochlorothiazide and cutaneous T cell lymphoma: Prospective analysis and case series. Cancer. 2013;119(4):825–31.

[11] Pai RK, Mullins FM, Kim YH, Kong CS. Cytologic evaluation of lymphadenopathy associated with mycosis fungoides and Sezary syndrome. Cancer. 2008;114(5):323–32.

[12] Inamadar AC, Ragunatha S. The rash that becomes an erythroderma. Clin Dermatol. 2019;37(2):88–98.

[13] Goodlad J, Calonje E. Cutaneous lymphoproliferative disease and related disorders. In: Calonje E. McKee’s pathology of the skin. Fifth edition. 2020. 1403–1519 p.

[14] Murray M. Diabetes Mellitus types I and II. In: Pizzorno JE. Textbook of natural medicine. Fifth edition. 2021. 1262 p.

[15] Durgin JS, Weiner DM, Wysocka M, Rook AH. The immunopathogenesis and immunotherapy of cutaneous T cell lymphoma: Pathways and targets for immune restoration and tumor eradication. J Am Acad Dermatol. 2021;84(3):587–95.

[16] Nguyen C V., Bohjanen KA. Skin-Directed Therapies in Cutaneous T-Cell Lymphoma. Dermatol Clin [Internet]. 2015;33(4):683–96. Available from: http://dx.doi.org/10.1016/j.det.2015.05.004

[17] Spicknall K. Sézary syndrome-clinical and histopathologic features, differential diagnosis, and treatment. Semin Cutan Med Surg. 2018;37(1):18–23.

[18] Serrano L, Martinez-Escala ME, Zhou XA, Guitart J. Pruritus in Cutaneous T-Cell Lymphoma and Its Management. Dermatol Clin. 2018;36(3):245–58.

Peripheral blood abnormality in Sezary Syndrome with bacteremia

Abstract

References

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