Primary Cutaneous Polymorphic EBV-Associated Posttransplant Lymphoproliferative Disorder After a Renal Transplant and Review of the Literature.
OBJECTIVE
Posttransplant lymphoproliferative disorder (PTLD) is an uncommon complication after solid organ transplants and hematopoietic stem cell transplants. Extranodal involvement in PTLD can involve several organ systems, including the central nervous system, bone marrow, lungs, gastrointestinal tract, and skin. Isolated involvement of the skin without systemic involvement in PTLD is rare. Primary cutaneous PTLD is generally categorized as either cutaneous T-cell lymphomas or cutaneous B-cell lymphomas, with variable Epstein-Barr virus (EBV) positivity. Herein, we describe an exceedingly uncommon case of a polymorphic variant of primary cutaneous PTLD.


METHODS
A woman in her 30s, who received an EBV+ deceased donor kidney transplant, presented with a 2-week history of 2 indurated patches over the lower abdomen. A skin biopsy revealed an atypical lymphoid proliferation with immunohistochemical stains demonstrating a mixed population of both B and T cells that stained strongly positive for EBV-encoded RNA. A bone marrow biopsy and positron emission tomography/computed tomography were negative for systemic involvement. The patient was treated with immunosuppression reduction and rituximab infusions.


CONCLUSIONS
This case highlights a rare polymorphic variant of primary cutaneous EBV-associated PTLD and increases awareness of this uncommon posttransplant complication. Cutaneous PTLD is reviewed, therefore dermatologists are aware of this uncommon disorder.
Departments of *Dermatology, †Medicine and VA Medical Center, ‡Medicine and Pharmacology, and §Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
Nkanyezi N
NN
Ferguson
Christie P
CP
Thomas
Raymond J
RJ
Hohl
Sergei I
SI
Syrbu
Mary S
MS
Stone
Karolyn A
KA
Wanat
D000328:Adult; D001706:Biopsy; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000821:virology*; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000821:virology*; D049268:Positron-Emission Tomography; D000069283:Rituximab / Q000627:therapeutic use; D017193:Skin Diseases, Viral / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000821:virology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab