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Guttate psoriasis in a patient with mycosis fungoides in treatment with Brentuximab vedotin: An unreported association

The relationship between psoriasis and cutaneous T-cell lymphomas (CTCL) is complex to address and still not fully understood: some authors have previously suggested that psoriatic patients may have an increased risk of developing CTCL due to chronic lymphoid prolifera-tion. 1 Furthermore, it has been well documented that several systemic therapies can be responsible for the development of drug-induced psoriasis. 2 Thus, it remains often challenging to investigate the concomitant occurrence of CTCL and psoriasis. Herein we report the first case of psoriasis developing in a mycosis fungoides (MF) patient treated with Brentuximab Vedotin (BV). A 69-year-old woman, diagnosed with MF in 2015, has been receiving treatments (i.e., corticosteroids, methotrexate, retinoids, phototherapy) in our university clinic for the past 5 years. At the end of 2020, the patient presented new diffuse plaques (Stage IB), with a 15% immunohistochemical expression ratio of CD30 + lympho-matous T-cells, and was started on the anti-CD30 drug BV (Schedule: IV 1.8 mg/kg every 3 week). 3 Soon the patient's lesions shrank, showing a remarkable clinical response. However, after six infusions, the patient suddenly developed multiple reddish, scaly, teardrop-shaped spots on her trunk and buttocks. A punch biopsy was performed and our clinical suspicion, consistent with the hypothesis of guttate psoriasis, was confirmed by the histopathology, which displayed acanthosis, parakeratotic mounds and foci of spongiform degeneration (Figure 1). No histological features compatible with MF or lymphomatoid papulosis, such as epidermotropism, Pautrier's microabscesses and atypical T-cells, were detected in the specimen. Remarkably,