Epstein–Barr virus‐associated B‐cell lymphoma in the setting of iatrogenic immune dysregulation presenting initially in the skin

Abstract

EBV-associated cutaneous B-cell lymphoma is characterized by a long interval between the initiation of immunosuppression and the development of lymphoma. Although previous reports have reported an indolent clinical course, an aggressive clinical course may occur. HHV8 and lytic phase EBV antigens are detected in some cases, possibly suggesting a pathogenetic role.

Methotrexate-related lymphoproliferative disorder with extensive vascular involvement in a patient with rheumatoid arthritis

“…9,16,[19][20][21] Notably, the most characteristic finding of the current case was the extensive vascular damage. The tunica media of dermal arterioles was infiltrated by tumor cells.…”

Methotrexate-associated lymphoproliferative disorder in a patient with rheumatoid arthritis presenting in the skin

“…LPDs arising in association with prolonged use of immunosuppressive drugs for maintenance of transplanted organs and the treatment of autoimmune diseases are now a well-recognized phenomenon. 1,4,5,11,15,17 Recently, it has become clear that these IR LPDs may rarely present within the skin, 15,16 necessitating awareness and an appropriate level of suspicion on the part of dermatologists and dermatopathologists.…”

“…2,4,[8][9][10][11][12][13][14] These MTX-associated LPDs (MTXLPDs) are identified and reported with increasing frequency, but cases presenting initially within the skin are uncommon. 15, 16 We describe a 91-year-old woman taking MTX for treatment of RA who presented with a localized eruption on her nose that spread to involve her cheeks, eyelids, and palate during the subsequent 6 months. Biopsy specimens taken on several occasions during the clinical course demonstrated a lymphoplasmacytic infiltrate that became progressively more atypical and eventually contained aggregates of large cells immunoreactive for both CD20 and CD30 but negative for EpsteinBarr virus (EBV).…”

Maligne Lymphome der Haut

“…In den letzten Jahren wurden zunehmend EBV-assoziierte, diffus-großzellige kutane B-Zell-Lymphome beschrieben, die in der Mehrzahl CD30-Antigen exprimieren. Obwohl Patienten mit derartigen Lymphomen meist eine schlechte Prognose aufweisen (nicht zuletzt wegen der Koexistenz mit der immunsupprimierenden Grunderkrankung), gibt es Einzelfälle mit Remission nach Aufheben der Immunsuppression oder antiviraler Therapie [24,25].…”