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Cutaneous Lymphoproliferative Disorder Complicating Infectious Mononucleosis in an Immunosuppressed Patient
Author(s) -
Owen Cindy England,
Callen Jeffrey P.,
Bahrami Soon
Publication year - 2011
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/j.1525-1470.2010.01087.x
Subject(s) - mononucleosis , medicine , immunosuppression , lymphoproliferative disorders , inflammatory bowel disease , epstein–barr virus infection , epstein–barr virus , immunology , virus , pathology , disease , lymphoma
Infectious mononucleosis is the syndrome produced by primary infection with Epstein‐Barr virus during adolescence or early adulthood. In immunosuppressed individuals, depressed T‐cell function allows the Epstein‐Barr virus‐driven B‐cell proliferation to continue unabated, potentially leading to a lymphoproliferative disorder. A 15‐year‐old girl with a history of ulcerative colitis treated with 6‐mercaptopurine and mesalamine presented with the acute onset of a rapidly enlarging, ulcerative nodule on her left lower eyelid 4 weeks following recovery from infectious mononucleosis. The biopsy revealed an Epstein‐Barr virus‐positive lymphoproliferative disorder. Systemic disease was absent. Following discontinuation of 6‐mercaptopurine, the patient was treated with two courses of intravenous cyclophosphamide. The lesion resolved completely and she remains disease free at 14 months following diagnosis. We report a solitary cutaneous lesion of an immunosuppression‐related lymphoproliferative disorder (IR‐LPD) occurring as a complication of infectious mononucleosis, and review the pathogenesis and reported cases of Epstein‐Barr virus‐related immunosuppression‐related lymphoproliferative disorder arising in the setting of inflammatory bowel disease. It is important for dermatologists and dermatopathologists to be aware of the occurrence of IR‐LPD in patients being treated for inflammatory conditions, including inflammatory bowel disease. Given the role of primary infection with Epstein‐Barr virus in the development of IR‐LPD, consideration may be given to assessing Epstein‐Barr virus status prior to initiating immunosuppressive therapy in young patients.