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Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes

Paraneoplastic autoimmune multiorgan syndrome (PAMS) is a life-threatening autoimmune disease associated with malignancies. Here, we present a patient initially misdiagnosed with “chronic” Stevens–Johnson syndrome. Over a year later, the patient was diagnosed with stage IV follicular lymphoma and tr...

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Autores principales: Gambichler, Thilo, Lee, Yi-Pei, Oschlies, Ilske, Scheel, Christina H., Klapper, Wolfram, Nowack, Nico, Doerler, Martin, Stücker, Markus, Abolmaali, Nasreddin, Susok, Laura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032549/
https://www.ncbi.nlm.nih.gov/pubmed/35448168
http://dx.doi.org/10.3390/curroncol29040194
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author Gambichler, Thilo
Lee, Yi-Pei
Oschlies, Ilske
Scheel, Christina H.
Klapper, Wolfram
Nowack, Nico
Doerler, Martin
Stücker, Markus
Abolmaali, Nasreddin
Susok, Laura
author_facet Gambichler, Thilo
Lee, Yi-Pei
Oschlies, Ilske
Scheel, Christina H.
Klapper, Wolfram
Nowack, Nico
Doerler, Martin
Stücker, Markus
Abolmaali, Nasreddin
Susok, Laura
author_sort Gambichler, Thilo
collection PubMed
description Paraneoplastic autoimmune multiorgan syndrome (PAMS) is a life-threatening autoimmune disease associated with malignancies. Here, we present a patient initially misdiagnosed with “chronic” Stevens–Johnson syndrome. Over a year later, the patient was diagnosed with stage IV follicular lymphoma and treated with an anti-CD20 antibody. At this time, his skin condition had significantly worsened, with erythroderma and massive mucosal involvement, including in the mouth, nose, eyes, and genital region. Histopathology revealed lichenoid infiltrates with interface dermatitis, dyskeratoses, necrotic keratinocytes, and a dense CD8+ infiltrate with strong epidermotropism. Direct and indirect immunofluorescence tests for autoantibodies were negative. Remarkably, we retrospectively discovered a chronic increase in peripheral CD8+ lymphocytes, persisting for over a year. Consequently, the patient was diagnosed with antibody-negative PAMS. Three weeks later, he succumbed to respiratory failure. This dramatic case highlights the challenges in diagnosing PAMS, particularly in cases where immunofluorescence assays are negative. Importantly, we observed, for the first time, a chronic excess of CD8+ peripheral blood lymphocytes, associated with PAMS, consistent with the systemic, autoreactive T-cell-driven processes that characterize this condition.
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spelling pubmed-90325492022-04-23 Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes Gambichler, Thilo Lee, Yi-Pei Oschlies, Ilske Scheel, Christina H. Klapper, Wolfram Nowack, Nico Doerler, Martin Stücker, Markus Abolmaali, Nasreddin Susok, Laura Curr Oncol Case Report Paraneoplastic autoimmune multiorgan syndrome (PAMS) is a life-threatening autoimmune disease associated with malignancies. Here, we present a patient initially misdiagnosed with “chronic” Stevens–Johnson syndrome. Over a year later, the patient was diagnosed with stage IV follicular lymphoma and treated with an anti-CD20 antibody. At this time, his skin condition had significantly worsened, with erythroderma and massive mucosal involvement, including in the mouth, nose, eyes, and genital region. Histopathology revealed lichenoid infiltrates with interface dermatitis, dyskeratoses, necrotic keratinocytes, and a dense CD8+ infiltrate with strong epidermotropism. Direct and indirect immunofluorescence tests for autoantibodies were negative. Remarkably, we retrospectively discovered a chronic increase in peripheral CD8+ lymphocytes, persisting for over a year. Consequently, the patient was diagnosed with antibody-negative PAMS. Three weeks later, he succumbed to respiratory failure. This dramatic case highlights the challenges in diagnosing PAMS, particularly in cases where immunofluorescence assays are negative. Importantly, we observed, for the first time, a chronic excess of CD8+ peripheral blood lymphocytes, associated with PAMS, consistent with the systemic, autoreactive T-cell-driven processes that characterize this condition. MDPI 2022-03-28 /pmc/articles/PMC9032549/ /pubmed/35448168 http://dx.doi.org/10.3390/curroncol29040194 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Gambichler, Thilo
Lee, Yi-Pei
Oschlies, Ilske
Scheel, Christina H.
Klapper, Wolfram
Nowack, Nico
Doerler, Martin
Stücker, Markus
Abolmaali, Nasreddin
Susok, Laura
Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes
title Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes
title_full Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes
title_fullStr Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes
title_full_unstemmed Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes
title_short Antibody-Negative Paraneoplastic Autoimmune Multiorgan Syndrome (PAMS) in a Patient with Follicular Lymphoma Accompanied by an Excess of Peripheral Blood CD8+ Lymphocytes
title_sort antibody-negative paraneoplastic autoimmune multiorgan syndrome (pams) in a patient with follicular lymphoma accompanied by an excess of peripheral blood cd8+ lymphocytes
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032549/
https://www.ncbi.nlm.nih.gov/pubmed/35448168
http://dx.doi.org/10.3390/curroncol29040194
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