Primary Cutaneous CD4 Small/Medium T-Cell Lymphoproliferative Disorder Following COVID-19 Vaccination-What Do We Know about Lymphoproliferative Disorders and Cutaneous Lymphomas after COVID-19 Vaccination? A Report of an Atypical Case and a Review of the Literature

Abstract

The association between Primary cutaneous CD4 small/medium T-cell lymphoproliferative disorder (PCSM-TCLPD) and COVID-19 immunization has been sparsely documented in the medical literature. Reviewing the literature, albeit infrequently, we can find cases of the recurrence and new onset of lymphoproliferative processes and cutaneous lymphomas following the COVID-19 vaccine. Many of the entities we encounter are classified as cutaneous lymphoproliferative disorders. The prevailing hypothesis suggests that the predominant cutaneous reactions to SARS-CoV-2 vaccines may stem from T-cell-mediated immune activation responses to vaccine components, notably messenger RNA (mRNA). Specifically, it is posited that the presence of cutaneous lymphoid infiltrates may be linked to immune system stimulation, supported by the absence, to date, of instances of primary cutaneous B-cell lymphoma following mRNA vaccination. Within this context, it is imperative to underscore that the etiological association between PCSM-TCLPD and COVID-19 vaccination should not discourage vaccination efforts. Instead, it underscores the necessity for continuous surveillance, in-depth investigation, and comprehensive follow-up studies to delineate the specific attributes and underlying mechanisms of such cutaneous manifestations post vaccination.

Keywords: CD4+ small/medium-sized T-cell lymphoproliferative disorder; COVID-19 vaccine; cutaneous lymphoma; cutaneous lymphoproliferative disorder.

Figure 1

Rose-colored, erythematous, well-demarcated nodules distributed on chest—located inside the circles—(A), left arm (B), and right arm, where the histological study of the more medial lesion was conducted (C).

Figure 1

Rose-colored, erythematous, well-demarcated nodules distributed on chest—located inside the circles—(A), left arm (B), and right arm, where the histological study of the more medial lesion was conducted (C).

Figure 2

Histological examination. (A) (Hematoxylin/eosin ×2): large accumulations of lymphoid infiltrate, with perianexial and perivascular distribution located in superficial and deep dermis in minimal contact with hypodermis. (B) (Hematoxylin/eosin ×10): absence of epidermotropism, showing a respected Grenz zone. (C) (Hematoxylin/eosin ×40): dermal infiltrate composed of a heterogeneous mixture of mainly T and B lymphocytes.

Figure 2

Histological examination. (A) (Hematoxylin/eosin ×2): large accumulations of lymphoid infiltrate, with perianexial and perivascular distribution located in superficial and deep dermis in minimal contact with hypodermis. (B) (Hematoxylin/eosin ×10): absence of epidermotropism, showing a respected Grenz zone. (C) (Hematoxylin/eosin ×40): dermal infiltrate composed of a heterogeneous mixture of mainly T and B lymphocytes.

Figure 3

Immunohistochemistry. (A) (Immunohistochemistry ×2): positive CD4 lymphocyte infiltrate. (B) (Immunohistochemistry ×20): small/medium cells with moderate cytological atypia and intermediate-sized elements showing positivity for the PD1 marker.

Figure 3

Immunohistochemistry. (A) (Immunohistochemistry ×2): positive CD4 lymphocyte infiltrate. (B) (Immunohistochemistry ×20): small/medium cells with moderate cytological atypia and intermediate-sized elements showing positivity for the PD1 marker.