Posttransplantation lymphoproliferative disease with features of lymphomatoid granulomatosis in a lung transplant patient

A 58-year-old lung transplant patient developed worsening shortness of breath and indurated erythematous plaques on the lower left leg. A skin biopsy specimen revealed a dense angiocentric and angioinvasive infiltrate in the mid to reticular dermis and panniculus containing large, atypical lymphocyt...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2006-04, Vol.54 (4), p.657-663
Main Authors: Kwon, Eun Ji, Katz, Kenneth A., Draft, Karla S., Seykora, John T., Rook, Alain H., Wasik, Mariusz A., Junkins-Hopkins, Jacqueline M.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Dermatology
Epstein-Barr Virus Infections - complications
Hematologic and hematopoietic diseases
Humans
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lung Diseases - etiology
Lung Diseases - pathology
Lung Transplantation - adverse effects
Lymphomatoid Granulomatosis - etiology
Lymphomatoid Granulomatosis - pathology
Lymphoproliferative Disorders - etiology
Lymphoproliferative Disorders - pathology
Lymphoproliferative Disorders - virology
Male
Medical sciences
Middle Aged
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Skin - pathology
Skin Diseases - etiology
Skin Diseases - pathology
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Description
Summary:A 58-year-old lung transplant patient developed worsening shortness of breath and indurated erythematous plaques on the lower left leg. A skin biopsy specimen revealed a dense angiocentric and angioinvasive infiltrate in the mid to reticular dermis and panniculus containing large, atypical lymphocytes with convoluted nuclei and prominent nucleoli. Immunohistochemical stains showed that the atypical cells were of B-cell origin, and that Epstein-Barr virus was present. Molecular studies demonstrated B-cell clonality. The patient was successfully treated with rituximab. The clinical and pathologic features in this case represent posttransplantation lymphoproliferative disease with features of lymphomatoid granulomatosis. The case also highlights the importance of clinical and pathologic examination of cutaneous lesions in the evaluation of lymphoproliferative disorders for patients undergoing transplantation.
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2005.11.1066