Abatement of Sézary syndrome lesions following treatment with acyclovir.

Sézary syndrome is a malignant form of cutaneous T cell lymphoma in which patients characteristically present with generalized pruritic erythroderma and large numbers of circulating Sézary cells in the peripheral blood. Several previous studies have proposed that viruses may play a role in the cause of cutaneous T cell lymphoma. This report describes a 68-year-old man with Sézary syndrome who received a seven-day course of intravenous acyclovir for treatment of disseminated herpes zoster and was noted to have almost complete disappearance of generalized erythroderma and pruritus. Since acyclovir has been shown to selectively inhibit viral DNA polymerase, the observed clinical response is strong evidence that viruses play a role in the cause of cutaneous T cell lymphoma. Mechanisms that could explain the observed response are discussed, and further studies on the utility of antiviral agents for treatment of cutaneous T cell lymphoma and on possible inhibitory effects of acyclovir on retroviruses are recommended.