Peripheral Neuropathy in Sézary Syndrome: Coincidence or a Part of the Syndrome?

Received/Geliş tarihi : May 8, 2013 Accepted/Kabul tarihi : June 10, 2013 To the Editor, A 48-year-old male patient was admitted with the complaints of diffuse skin dryness, fatigue, and numbness of the hands. He reported cramps and fasciculation occurring at nights and weakness of the arms. His physical examination (AG) revealed a diffuse dryness with widespread squames on the scalp, trunk, arms, and thighs (Figure 1). Neurological examination revealed hypoactive deep tendon reflexes in both lower extremities and hypoesthesia of gloves-socks type. His white blood cell count was 43,600/mm3, 50%-55% of which comprised eosinophils. Flow cytometry revealed a Sézary cell count of 3200/μL, a CD4/CD8 ratio greater than 22.5, and less than 7% T-cells that expressed CD7. The same clonal amplification was demonstrated by T-cell receptor gene analysis of skin, blood, and lymph nodes. Computerized tomography showed axillary and inguinal lymphadenopathies. The patient was at stage IIA. Biopsies from skin lesions and lymph nodes were performed. Immunohistochemical examination was consistent with SS, showing diffuse CD4 staining. Diagnosis of motor axonal neuropathy was based on the decrease of compound muscle action potential amplitudes of right median, peroneal, and bilateral posterior tibial nerves in a nerve conduction study. Other etiologies for motor axonal neuropathy such as diabetes mellitus were excluded. PUVA therapy was used for his skin lesions. Photopheresis was performed once a month. After the therapy, his neuropathy improved. Discussion