CD30+ T-cell lymphoma following Chimeric Antigen Receptor T-cell therapy (CART-cell therapy) - Diagnostic uncertainty in a postimmunotherapy setting

Sep 30, 2026

Uploaded by Patrick

Chimeric antigen receptor (CAR) T-cell therapy treats hematologic malignancies but can rarely lead to T-cell lymphoproliferative disorders. This case report describes a 76-year-old man with prior B-cell maturation agent-directed ciltacabtagene autoleucel CAR-T therapy who developed a solitary pink plaque on the chin nine months later. Initial clinical features were nonspecific and mimicked other dermatologic conditions, while biopsy confirmed CD30-positive cutaneous T-cell lymphoma with low-grade lineage arising from CAR-T cells. Symptoms regressed spontaneously after initial evaluation, yet recurrence occurred with tongue involvement, supported by histology and abnormal T-cell flow cytometry.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Case report

Clinical presentation

Diagnostic workup

Follow-up and outcomes

CASE REPORT CD30+ T-cell lymphoma following Chimeric Antigen Receptor T-cell therapy (CART-cell therapy): Diagnostic uncertainty in a postimmunotherapy setting Madison McClanahan , BA,a and Madison Stokes, MDb Key words: CAR-T cell therapy; CD301 lymphoma; CD30-positive lymphoma; cutaneous T-cell lymphoma; dermatology; immune reconstitution; lymphoproliferative disorders; multiple myeloma; oncology; secondary malignancy; solitary cutaneous lesion; spontaneous regression. INTRODUCTION Chimeric antigen receptor (CAR) T-cell therapy is a novel immunotherapeutic approach increasingly employed in the treatment of hematologic malignancies, including B-cell leukemias, lymphomas, and multiple myeloma.1,2 The process involves isolation of autologous or allogeneic T cells from peripheral blood, which are genetically engineered to express synthetic CAR proteins. These modified T cells undergo clonal expansion and arereinfused into the patient following lymphodepleting chemotherapy, which enhances CAR-Tcell survival and activity.1 Upon administration, CAR-T cells recognize tumor-associated antigens and mediate cytotoxicity through perforin and granzyme pathways.1 This therapy has demonstrated remarkable efficacy, even in malignancies that are refractory to conventional treatment.3 However, the use of CAR-T cell therapy is associated with serious adverse effects, including cytokine release syndrome, neurologic toxicity, and prolonged cytopenias.3 More recently, rare reports have described the emergence of T-cell lymphoproliferative disorders following this treatment.4-8 These have predominantly presented as systemic disease, whereas isolated cutaneous presentations remain uncommon. This report describes a case of biopsy-confirmed CD30-positive peripheral From the College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansasa; and Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. b Funding sources: None. Patient consent: The authors obtained written consent from patients for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors. IRB approval status: Not applicable. Abbreviation used: CAR: chimeric antigen receptor T-cell lymphoma with skin involvement asthe solitary sight of initial presentation, arising in a patient with a recent history of B-cell maturation agent-directed CAR-T therapy. The case illustrates a variation in the usual clinical course, characterized by solitary skin involvement and regression without treatment, and raises questions about how postimmunotherapy immune modulation may influence atypical lymphoid proliferations. CASE REPORT In May 2025, a 76-year-old male with a history of multiple myeloma most recently treated via B-cell maturation agent-directed ciltacabtagene autoleucel CAR-T cell therapy 9 months prior presented to the dermatology clinic with a 1-month history of a new pink plaque on the anterior chin. He denied systemic symptoms, including fever, night sweats, and weight loss. On examination, a solitary, well-demarcated, erythematous pink plaque measuring approximately 3 cm was noted on the anterior chin (Fig 1) . The lesion Correspondence to: Madison McClanahan, BA, College of Medicine, University of Arkansas for Medical Sciences (UAMS), 4301 W Markham St, Little Rock, AR 72205. E-mail: [mrmcclanahan@uams.edu](mrmcclanahan@uams.edu). JAAD Case Reports 2026;67:226-9 . 2352-5126 © 2025 The Author(s) . Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc. This is an open access article under the CC BY license ([http://creativecommons.org/](http://creativecommons.org/)[ ](http://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) . [https://doi.org/10.1016/j.jdcr.2025.1](https

FAQs

What treatment history preceded the patient’s skin lesion?

The patient previously received B-cell maturation agent-directed ciltacabtagene autoleucel CAR-T cell therapy for multiple myeloma about nine months before the dermatology visit.

How was the lesion diagnosed as CD30-positive cutaneous T-cell lymphoma?

A punch biopsy and subsequent incisional biopsy showed CD30-positive cutaneous T-cell lymphoma; genomic testing on an additional sample confirmed a low-grade T-cell lymphoma arising from CAR-T cells, supported by abnormal T-cell flow cytometry.

What was unusual about the clinical course in this case?

Despite diagnostic concern for malignancy, the original chin plaque completely regressed without treatment, followed later by recurrence as a tongue lesion involving the same lymphoma.

Sep 30, 2026

Uploaded by Patrick