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Association of erythrodermic cutaneous T-cell lymphoma, superantigen-
positive Staphylococcus aureus, and oligoclonal T-cell receptor V beta gene
expansion
CM Jackow, JC Cather, V Hearne, AT Asano, JM Musser and M Duvic
Department of Dermatology, University of Texas Medical School, Houston,
USA.
Forty-two patients with cutaneous T-cell lymphoma, including 31 with
exfoliative erythroderma or Sezary syndrome and 11 with mycosis fungoides,
were studied for the occurrence of staphylococcal infection. Thirty-two of
42 (76%) had a positive staphylococcal culture from skin or blood. One half
of the patients with positive cultures grew Staphylococcus aureus. This
group included 11 with Sezary syndrome and 5 with rapidly enlarging mycosis
fungoides plaques or tumors. All of the S aureus carried enterotoxin genes.
Surprisingly, 6 of 16 strains were the same toxic shock toxin-1
(TSST-1)-positive clone, designated electrophoretic type (ET)-41. Analysis
of the T-cell receptor V beta repertoire in 14 CTCL patients found that
only 4 had the expected monoclonal expansion of a specific V beta gene,
whereas 10 had oligoclonal or polyclonal expansion of several V beta
families. All patients with TSST-1+ S aureus had overexpansion of V beta Z
in blood and/or skin lesions. These studies show that S aureus containing
superantigen enterotoxins are commonly found in patients with CTCL
especially individuals with erythroderma where they could exacerbate and/or
perpetuate stimulate chronic T-cell expansion and cutaneous inflammation.
Attention to toxigenic S aureus in CTCL patients would be expected to
improve the quality of care and outcome of this patient population.
Volume 89,
Issue 1,
pp. 32-40,
01/01/1997
Copyright © 1997 by The American Society of Hematology
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