Cutaneous atypical papular CD8+ lymphoproliferative disorder at acral sites in a renal transplant patient

Abstract

A 20-year-old woman presented with a 2-month history of an acute symmetrical eruption, manifesting as asymptomatic ill-defined erythematous macules and hyperkeratotic papules on the palms. The patient was a renal transplant recipient, and the lesions had developed 2 months post-transplantation. Histologically, the eruption shared features of a reactive inflammatory condition called papular eruption of atypical CD8+ lymphocytes as well as primary cutaneous acral CD8+ T-cell lymphoma (a provisional indolent entity in the new World Health Organisation classification of lymphoid neoplasms, 2016). The latter disorder has been described to occur at acral sites in immunocompetent patients, whereas the former has previously been described only in patients infected with human immunodeficiency virus. The lesions in our patient healed after topical treatment with corticosteroids and alteration of immunosuppressive therapy, supporting the role of immunosuppression in this case. We classified our patient's condition as lying in the spectrum of the aforementioned two conditions, but the relationship between both diseases remains to be clarified. Awareness of these unusual conditions may prevent the use of unnecessary aggressive therapies in similar patients.

Cutaneous pseudolymphoma—A review on the spectrum and a proposal for a new classification

“…CD8+ T‐cell pseudolymphoma in immunodeficiency occurs particularly in patients with HIV infection, especially in those with profound immunosuppression and a high viral load . Similar features were recently described in renal transplant recipients . A broad clinical spectrum is reported, including infiltrated red plaques, erythroderma, palmoplantar hyperkeratosis, and generalized lymphadenopathy .…”

Inflammatory and infectious skin diseases presenting as cutaneous pseudolymphoma

“…Patients with severe immunosuppression due to insufficiently/ untreated HIV infection or transplant recipient can present this extremely rare form of cPSL. 25,26 The clinical spectrum encompasses plaques, erythroderma, palmoplantar hyperkeratosis and generalized lymphadenopathy. 27e29 Worsening after ultraviolet light exposure has been reported.…”