Michel J L, Perrot J L, Mitanne D, Boucheron S, Fond L, Cambazard F
Service de Dermatologie, Hôpital Nord, CHU de Saint-Etienne.
Ann Dermatol Venereol. 1996;123(8):478-82.
Skin cancers are more frequent and more aggressive in immunosuppressed patients.
A 58-year-old man was seen in January 1994 for squamous cell carcinoma of the right shoulder which had grown to 7 x 7 cm in the last 5 months. The patient had a past history of surgical exeresis of 5 squamous cell carcinomas and 3 basal cell carcinomas. Despite complete exeresis, the disease spread to localized then diffuse skin metastases. Acitretine and alpha-interferon were uneffective. Polychemotherapy stabilized the situation but several bronchopulmonary infections with atypical germs led to death (in February 1995). The patient had CD4 lymphocytopenia with a count < 100/mm3 in January 1994 of unknown origin (viral infection was eliminated).
Our patient had idiopathic CD4 lymphocytopenia. In 40 p. 100 of the cases CD4 lymphocytopenia is caused by AIDS and in 53 p. 100 by other diseases, especially skin diseases including Kaposi syndrome, mycosis fungoides, squamous cell or basal cell carcinoma. The cutaneous carcinomas which often develop in AIDS patients with low CD4 counts are usually less aggressive than in our patient. Certain neoplasia could be the cause of the lymphopenia. CD4 counts are usually more variable and lymphopenia of shorter duration in other etiologies.
皮肤癌在免疫抑制患者中更为常见且更具侵袭性。
一名58岁男性于1994年1月因右肩部鳞状细胞癌前来就诊，该肿瘤在过去5个月内已长至7×7厘米。患者既往有5次鳞状细胞癌和3次基底细胞癌的手术切除史。尽管进行了彻底切除，但疾病仍扩散至局部，随后出现弥漫性皮肤转移。阿维A和α干扰素治疗无效。多药化疗使病情稳定，但几次由非典型病菌引起的支气管肺部感染导致患者死亡（1995年2月）。1994年1月患者出现CD4淋巴细胞减少，计数<100/mm³，病因不明（病毒感染已排除）。
我们的患者患有特发性CD4淋巴细胞减少症。在40%的病例中，CD4淋巴细胞减少由艾滋病引起，53%由其他疾病引起，尤其是包括卡波西肉瘤、蕈样肉芽肿、鳞状细胞癌或基底细胞癌在内的皮肤病。CD4计数低的艾滋病患者中常发生的皮肤癌通常不如我们的患者侵袭性强。某些肿瘤可能是淋巴细胞减少的原因。在其他病因中，CD4计数通常更具变异性，淋巴细胞减少持续时间更短。
