Post‐transplant lymphoproliferative disorder with cutaneous involvement: A series of four cases

Background Post‐transplant lymphoproliferative disorders (PTLD) are lymphoid proliferations associated with post‐transplant immunosuppression. Most originate from B cells and are associated with Epstein‐Barr virus (EBV) infection. Although extranodal involvement is common, cutaneous presentation is...

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Bibliographic Details
Published in:Clinical transplantation 2021-02, Vol.35 (2), p.e14162-n/a
Main Authors: Ferreira, Maria Carolina Corsi, Arai Seque, Camila, Enokihara, Mílvia Maria Simões e Silva, Batista, Mariana Dias, Tomimori, Jane, Porro, Adriana Maria
Format: Article
Language:English
Subjects:
Epstein-Barr Virus Infections - etiology
Herpesvirus 4, Human
Humans
kidney transplantation
Kidney Transplantation - adverse effects
lymphoma
lymphoproliferative disorders
Lymphoproliferative Disorders - diagnosis
Lymphoproliferative Disorders - etiology
Retrospective Studies
skin
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Summary:Background Post‐transplant lymphoproliferative disorders (PTLD) are lymphoid proliferations associated with post‐transplant immunosuppression. Most originate from B cells and are associated with Epstein‐Barr virus (EBV) infection. Although extranodal involvement is common, cutaneous presentation is rare. Objective To report and characterize cutaneous manifestations of PTLD from clinical, histopathologic, and immunohistochemistry standpoints. Methods Patients' information was obtained retrospectively by reviewing medical records. Skin biopsies were submitted to histological and immunohistochemistry analysis, and EBV detection was performed by in situ hybridization and polymerase chain reaction (PCR) analysis. Staging examinations were included. A literature review of reported cutaneous PTLD cases was performed. Results We describe two cases of primary cutaneous and 2 cases of systemic PTLD with secondary cutaneous manifestations. All had late onset disease, which presented at least 6 years after transplantation. Histopathologic findings were compatible with monomorphic PTLD in three cases and plasmacytic hyperplasia in one case. EBV was detected in two patients. Both patients with systemic disease had fatal outcome, and those with primary cutaneous involvement responded to treatment. Limitations Due to the rare incidence of cutaneous manifestation of PTLD, the analysis of a large number of cases was not possible. Conclusion Although rare, PTLD should be considered in the differential diagnosis of late onset cutaneous complications post‐renal transplant.
ISSN:0902-0063
1399-0012
DOI:10.1111/ctr.14162