Very late-onset EBV-related cutaneous post-transplant lymphoproliferative disorder

The Epstein-Barr Virus-related cutaneous post-transplant lymphoproliferative disorder (EBV-cPTLD) is an exceptional complication of the immediate post-transplant period, related to the immunosuppression leading to EBV reactivation. EBV-cPTLD presents a heterogeneous dermatological spectrum complicating the diagnosis, hence requiring histology, immunohistochemistry (IHC) and in situ hybridisation (ISH) for confirmation.A woman in her 70s with a 24 year history of renal transplantation presented atypical infiltrated, hyperpigmented lesions on the left arm and leg along with general health deterioration. Histology, IHC and ISH on skin biopsy demonstrated an EBV-positive infiltration, confirming plasmablastic lymphoma, a form of EBV-cPTLD. A Positron Emission Tomography/Computed Tomography (PET/CT) demonstrated hypermetabolic cutaneous and bone infiltrations that resolved after an rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone treatment.This case illustrates that cPTLD should be included in the differential diagnosis of atypical skin lesions, even decades after transplantation. Although retrieving EBV in late cPTLD is exceptional, this case shows that proliferating EBV can be demonstrated in very late-onset cPTLD.