Age-related Epstein-Barr virus-positive cutaneous ulcer arising after a self-limited subcutaneous abscess: a case report

Abstract

IntroductionEpstein-Barr virus-positive mucocutaneous ulcer is a newly recognized clinicopathologic entity in the spectrum of Epstein-Barr virus-positive lymphoproliferative disorders. This entity is characterized by a self-limited, indolent course.Case presentationWe report the case of a 74-year-old, type 2 diabetic man who presented with an ulceroinfiltrative skin lesion on the left side of his neck. Histological examination showed that the lesion consisted of large atypical cells, some with Hodgkin-Reed-Sternberg-like morphology, in the midst of reactive lymphocytes, plasma cells, eosinophils and histiocytes. The atypical cells were partially positive for CD45, CD20, CD79a, CD30, B-cell lymphoma 2 and latent membrane protein 1 (CS.1-4), and negative for CD15, B-cell lymphoma 6 and CD10. In situ hybridization for Epstein-Barr virus-encoded ribonucleic acid was positive. Two years before, the patient had been diagnosed with a self-limited subcutaneous abscess in the same anatomic area that healed after antibiotic therapy.ConclusionOlder patients with positive Epstein-Barr virus serology may develop B-cell lymphoproliferations due to age-related immune suppression. Epstein-Barr virus-encoded ribonucleic acid testing and clonality analysis, eventually complemented with close clinical follow-up, should be performed for suspicious inflammatory lesions in older patients.

Comparison of Epstein–Barr virus‐positive mucocutaneous ulcer associated with treated lymphoma or methotrexate in Japan

“…There were some differences in the predisposing factors in the EBVMCU patients in Western versus Eastern countries. Specifically, EBVMCU was associated with iatrogenic immunosuppressive drugs in 38% of Western patients, with age‐related immunosenescence in 36%, and with transplantation and other factors in 26% . In Eastern countries, EBVMCU was reported in the setting of iatrogenic immunosuppressive drug use for autoimmune disease in 59% of patients, post‐chemotherapy in 36%, and in association with other factors in 5% .…”

“…Specifically, EBVMCU was associated with iatrogenic immunosuppressive drugs in 38% of Western patients, with age-related immunosenescence in 36%, and with transplantation and other factors in 26%. 2,3,5,6,10,11,[14][15][16][17][18][19][20][21][22][23][24][25][26] In Eastern countries, EBVMCU was reported in the setting of iatrogenic immunosuppressive drug use for autoimmune disease in 59% of patients, post-chemotherapy in 36%, and in association with other factors in 5%. 4,12,[27][28][29] The prevalence of autoimmune disease, e.g.…”

Epstein–Barr Virus-Positive Mucocutaneous Ulcer: A Unique and Curious Disease Entity

“…In 186 EBVMCU cases [ 5 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ], during the follow-up periods (1–180 months), spontaneous improvement of the ulcers was noted in eight patients, and 126 patients had either complete or partial remission after discontinuation or dose reduction of immunosuppressants, chemotherapy, or radiotherapy. While eight patients experienced recurrence [ 15 , …”

Epstein–Barr Virus in Cutaneous Pathology

“…10,165 Ulcers commonly occur in patients older than 50 years and they usually seem in the setting of immunosuppression, including that is due to chemotherapy, 10 or those induced as a treatment for some dermatologic conditions. 10,165 Ulcers commonly occur in patients older than 50 years and they usually seem in the setting of immunosuppression, including that is due to chemotherapy, 10 or those induced as a treatment for some dermatologic conditions.…”