A Case of Tofacitinib-Induced Lymphomatoid Papulosis With Ocular Involvement. (4th July 2022)

• Record Type: Journal Article
• Authors: Knapp, Calvin; Steele, Eric; Mengden-Koon, Stephanie; Williams, Todd; Fett, Nicole
• Is Part Of: American journal of dermatopathology. Volume 44:Number 7(2022)
• Page Start: 523
• Page End: 525
• Publication Date: 2022-07-04
• Subjects: JAK inhibitor -- lymphomatoid papulosis -- tofacitinib -- lymphoproliferative disorders; Skin -- Diseases -- Periodicals; Histology, Pathological -- Periodicals; 616.50705
• DOI: 10.1097/DAD.0000000000002219
• Languages: English
• ISSNs: 0193-1091

Abstract

Abstract: Janus kinase (JAK) inhibitors are being prescribed with increasing regularity in dermatology. We report on a patient who initiated treatment with tofacitinib for refractory erythema elevatum diutinum and subsequently developed a novel cutaneous outbreak characterized by firm violaceous papules on the trunk and extremities along with conjunctival injection and periorbital inflammation. Biopsy of affected tissue from both the cutaneous and ophthalmologic sources demonstrated increased numbers of CD30 + large atypical cells amid a mixed inflammatory cell infiltrate, consistent with lymphomatoid papulosis. A review of the literature reveals a plausible mechanism for the induction of persistent JAK signaling in the presence of a JAK inhibitor. We discuss this mechanism in depth because it pertains to this patient and recommend continued vigilance with the use of these immunologic agents.