Kaposi's sarcoma after T‐cell costimulation blockade with abatacept in rheumatoid arthritis: a case report. (6th March 2017)

• Record Type: Journal Article
• Authors: Olivo, D.; Grembiale, R. D.; Tallarigo, F.; Russo, E.; De Sarro, G.; Ursini, F.
• Is Part Of: Journal of clinical pharmacy and therapeutics. Volume 42:Number 3(2017)
• Page Start: 367
• Page End: 369
• Publication Date: 2017-03-06
• Subjects: abatacept -- case report -- costimulation -- CTLA4‐Ig -- HHV‐8 -- human herpesvirus 8 -- Kaposi's sarcoma -- rheumatoid arthritis -- T cells -- T cells costimulation; Clinical pharmacology -- Periodicals; Chemotherapy -- Periodicals; 615
• DOI: 10.1111/jcpt.12510
• Languages: English
• ISSNs: 0269-4727

Abstract

Summary: What is known and objective: Kaposi's sarcoma (KS) is a malignant neoplasm caused by HHV‐8, a pathogen that leads to endothelial cell transformation when host defences are weakened. Case description: Here we report the first case of KS during treatment with abatacept, a biologic agent targeting T‐cell costimulation. The patient was a 64‐year‐old female with rheumatoid arthritis who developed multiple firm, purple‐reddish nodules on the dorsal aspect of the right hand. Histological examination confirmed KS. What is new and conclusion: Although a direct causal relationship between KS development and abatacept treatment cannot be proved, we hypothesize a role for costimulation blockade. Abstract : Schematic representation of the hypothetical mechanism leading to KS development in our patient. Unrecognized HHV‐8 infection could induce CD80/86 downregulation in endothelial cells; the superimposed CD80/86 blockade after treatment with abatacept could subsequently abrogate T cell recognition of infected cells and open the way for malignant transformation.