Cutaneous lymphoproliferative disorder complicating infectious mononucleosis in an immunosuppressed patient.
Infectious mononucleosis is the syndrome produced by primary infection with Epstein-Barr virus during adolescence or early adulthood. In immunosuppressed individuals, depressed T-cell function allows the Epstein-Barr virus-driven B-cell proliferation to continue unabated, potentially leading to a lymphoproliferative disorder. A 15-year-old girl with a history of ulcerative colitis treated with 6-mercaptopurine and mesalamine presented with the acute onset of a rapidly enlarging, ulcerative nodule on her left lower eyelid 4 weeks following recovery from infectious mononucleosis. The biopsy revealed an Epstein-Barr virus-positive lymphoproliferative disorder. Systemic disease was absent. Following discontinuation of 6-mercaptopurine, the patient was treated with two courses of intravenous cyclophosphamide. The lesion resolved completely and she remains disease free at 14 months following diagnosis. We report a solitary cutaneous lesion of an immunosuppression-related lymphoproliferative disorder (IR-LPD) occurring as a complication of infectious mononucleosis, and review the pathogenesis and reported cases of Epstein-Barr virus-related immunosuppression-related lymphoproliferative disorder arising in the setting of inflammatory bowel disease. It is important for dermatologists and dermatopathologists to be aware of the occurrence of IR-LPD in patients being treated for inflammatory conditions, including inflammatory bowel disease. Given the role of primary infection with Epstein-Barr virus in the development of IR-LPD, consideration may be given to assessing Epstein-Barr virus status prior to initiating immunosuppressive therapy in young patients.
Owen
Cindy England
CE
Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky 40202, USA. ceowen01@louisville.edu
Callen
Jeffrey P
JP
Bahrami
Soon
S
D000293:Adolescent; D001706:Biopsy; D005141:Eyelid Diseases / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007244:Infectious Mononucleosis / Q000188:drug therapy* / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000276:immunology* / Q000473:pathology; D012871:Skin Diseases / Q000276:immunology* / Q000473:pathology
D007166:Immunosuppressive Agents