Unusual case of B cell lymphoma after immunosuppressive treatment for psoriasis

Lymphomas may be induced by the systemic immunosuppressive therapies used to treat psoriasis,such as ciclosporin,methotrexate and tumour necrosis factor(TNF)-α blockers.The biologic agents currently used in psoriasis include alefacept,efalizumab,and the TNF-α antagonists etanercept,infliximab,and adalimumab.Infections and cancer are the main possible consequences of intended or unexpected immunosuppression.We report a 59-year-old man with a history of severe psoriasis vulgaris treated with traditional immunosuppressant drugs followed by anti-TNF-α therapy;the patient was firstly hospitalized for an acute cholestatic toxic hepatitis,which we supposed to be related to adalimumab.The first liver biopsy showed active disease with severe hepatocellular damage caused by heavy lymphocytes infiltrate in portal tracts at in the interface with a not conclusive diagnosis of lymphoproliferative disease.The correct diagnosis of T cell/histiocyte-rich large B cell lymphoma(T/HRBCL) was only reached through a gastric biopsy and a second liver biopsy.T/HRBCL is an uncommon morphologic variant of diffuse large B-cell lymphoma not described until now in psoriatic patients receiving immunosuppressive biologic agents.In psoriatic patients,treated with biologic immunosuppressive agents,the suspect of abdominal lymphoma should always be included as differential diagnosis.Abdominal ultrasound evaluation need therefore to be included in the pretreatment screening as in the follow-up surveillance.

Spirohypertones A and B as potent antipsoriatics:Tumor necrosis factor-αinhibitors with unprecedented chemical architectures

Tumor necrosis factor-α(TNF-α)is a promising target for inflammatory and autoimmune diseases.Spirohypertones A(1)and B(2),two unprecedented polycyclic polyprenylated acylphloroglucinols with highly rearranged skeletons,were isolated from Hypericum patulum.The structures of 1 and 2 were confirmed through comprehensive spectroscopic analysis,single-crystal X-ray diffraction and electronic circular dichroism calculations.Importantly,2 showed remarkable TNF-αinhibitory activity,which could protect L929 cells from death induced by co-incubation with TNF-αand actinomycin D.It also demonstrated the ability to suppress the inflammatory response in HaCaT cells stimulated with TNF-α.Notably,in an imiquimod-induced psoriasis murine model,2 restrained symptoms of epidermal hyperplasia associated with psoriasis,presenting anti-inflammatory and antiproliferative effects.This discovery positions 2 as a potent TNF-αinhibitor,providing a promising lead compound for developing an antipsoriatic agent.