Lymphomatoid Papulosis in a 37-year-old Woman with Relapsing Multiple Sclerosis Treated with Dimethyl Fumarate (P5.375)

Objective: NA Background: NA Design/Methods: NA Results: A 37-year-old woman with relapsing multiple sclerosis on dimethyl fumarate (DMF) developed raised red papules on her skin, some of which ulcerated, approximately six months after initiating DMF. She had been diagnosed with multiple sclerosis (MS) approximately two years prior after an episode of hemi-body sensory loss and subsequent MRI imaging consistent with MS. After developing skin lesions on her arms and abdomen she had a dermatology evaluation and skin biopsy. Biopsy results were consistent with lymphomatoid papulosis (LyP), a rare and often chronic cutaneous lymphoproliferative disorder involving CD30 cells. This has been associated with the development of lymphoma in some patients, both cutaneous and systemic forms. DMF was discontinued out of concern this was the inciting factor; however, the patient continued to have new skin lesions. Conclusions: DMF modulates the T-cell immune response, promoting a Th2 rather than Th1 response, and inhibits NF-κB signaling. This case is notable as LyP is a rare condition which neurologists should be aware of and has been reported in MS patients. In addition, DMF is being investigated as a possible therapeutic option in cutaneous T-cell lymphoma as it has shown apoptosis induction in mice via NF-κB modulation; it is especially unusual that our patient developed LyP in spite of her treatment with DMF. The clinical significance of this finding is unclear, however, the occurrence of LyP is important to note in order to better understand the pathogenesis and T-cell modulatory effects of DMF in other organ systems. Disclosure: Dr. George has nothing to disclose. Dr. Kheterpal has nothing to disclose. Dr. Miller has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Accordant Health Services (Caremark), Adama, BiogenIdec, Celgene, Genzyme/Sanofi, Mallinckrodt, Mapi-Pharma, Novartis, Roche/Genentech.