Posttransplantation lymphoproliferative disease with features of lymphomatoid granulomatosis in a lung transplant patient.
A 58-year-old lung transplant patient developed worsening shortness of breath and indurated erythematous plaques on the lower left leg. A skin biopsy specimen revealed a dense angiocentric and angioinvasive infiltrate in the mid to reticular dermis and panniculus containing large, atypical lymphocytes with convoluted nuclei and prominent nucleoli. Immunohistochemical stains showed that the atypical cells were of B-cell origin, and that Epstein-Barr virus was present. Molecular studies demonstrated B-cell clonality. The patient was successfully treated with rituximab. The clinical and pathologic features in this case represent posttransplantation lymphoproliferative disease with features of lymphomatoid granulomatosis. The case also highlights the importance of clinical and pathologic examination of cutaneous lesions in the evaluation of lymphoproliferative disorders for patients undergoing transplantation.
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Eun Ji
EJ
Kwon
Kenneth A
KA
Katz
Karla S
KS
Draft
John T
JT
Seykora
Alain H
AH
Rook
Mariusz A
MA
Wasik
Jacqueline M
JM
Junkins-Hopkins
D020031:Epstein-Barr Virus Infections / Q000150:complications; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000473:pathology*; D016040:Lung Transplantation / Q000009:adverse effects*; D008230:Lymphomatoid Granulomatosis / Q000209:etiology / Q000473:pathology*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000209:etiology / Q000473:pathology*