Azathioprine‐induced EBV‐positive mucocutaneous ulcer

Abstract

Epstein-Barr virus (EBV)-positive mucocutaneous ulcer was recently described as a clinicopathologic entity occurring secondary to iatrogenic or age-related immune suppression. The histopathology of EBV-positive mucocutaneous ulcer reveals a polymorphous infiltrate including atypical large B-cells and Reed-Sternberg-like cells which are CD20-positive, CD30-positive and EBV-positive. The disorder follows an indolent and self-limited course. We report a case of EBV-positive mucocutaneous ulcer secondary to prolonged use of azathioprine for the treatment of pemphigoid and highlight the need for recognition of this disorder by dermatopathologists and dermatologists.

Oral ulceration associated with concurrent herpes simplex virus, cytomegalovirus, and Epstein-Barr virus infection in an immunocompromised patient

“…Since then, additional cases have been reported. 31,[54][55][56][57] Despite the similarly indolent clinical course of the present case, our patient's lesion did not display the histopathologic features of an EBV-positive mucocutaneous ulcer. Additionally, our patient was highly immunosuppressed, unlike the other reported patients.…”

Chronic Active Epstein-Barr Virus Infection-Associated Hydroa Vacciniforme-Like Eruption and Behçet's-Like Orogenital Ulcers

“…As they occur as a result of viremia and immunologic reaction, viral DNA and protein do not need to be present in the tissue [6,7,8,9,10]. On the other hand, EBV-positive mucocutaneous ulcers also have been described as a distinct clinicopathologic entity secondary to immunosuppression [11,12]. They present as isolated and sharply circumscribed ulcers involving the skin, oropharyngeal mucosa or gastrointestinal tract.…”

“…The cutaneous manifestations are similar to typical HV with recurrent photodistributed papulovesicles, which ulcerate, crust and heal with vacciniform scars. Although rare, mucocutaneous ulcers can also be a feature of EBV-associated disorders and have been described as a feature of primary infection or immunodeficiency-induced lymphoproliferative disorders [5,6,7,8,9,10,11,12]. …”

Pathologic Diagnosis of Cutaneous Lymphomas

“…134 One-third of the affected patients have a drug-related immunosuppression, but age-related immune suppression is also a feature. 134,135 Polymorphous infiltrates of atypical large B-cell blasts, often with Hodgkin or Reed-Sternberg cell-like morphology in the background of abundant small T cells and eosinophils, are found. The large cells express CD20 and CD30 and are positive for EBER.…”