Epstein–Barr virus‐encoded <scp>RNA </scp><i>in‐situ</i> hybridization on non‐specific ulcerative skin lesions of immunosuppressed patients

Fujimoto, Masakazu; Basko-Plluska, Juliana; Shea, Christopher R.

doi:10.1111/his.12644

Cited by 4 publications

(9 citation statements)

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“…The other finding that suggested the causal relationship with EBV was the high number of EBV‐positive lymphocytes. The presence of EBER‐positive lymphocytes in the skin seems to be a rare phenomenon even for patients under immunosuppression . Retrospectively, we have performed EBER on three skin biopsies from three different RA patients (two were on MTX and one was on prednisolone) histologically diagnosed with vasculitis or with a suspicion of vasculitis in our pathology archives, but few positive cells were observed (mean 2/HPF, median 0/HPF, range: 0–6/HPF).…”

Section: Discussionmentioning

confidence: 99%

“…The presence of EBER-positive lymphocytes in the skin seems to be a rare phenomenon even for patients under immunosuppression. 19 Retrospectively, we have performed EBER on three skin biopsies from three different RA patients (two were on MTX and one was on prednisolone) histologically diagnosed with vasculitis or with a suspicion of vasculitis in our pathology archives, but few positive cells were observed (mean 2/HPF, median 0/HPF, range: 0-6/HPF). In addition, we have performed EBER on six non-specific skin ulcers from six different RA patients (three were on MTX, two were on cyclosporine, and one was on tacrolimus), but no cases showed over 50/HPF EBER-positive cells (mean 10.5/HPF, median 2/HPF, range: 0-40/HPF).…”

Section: Discussionmentioning

confidence: 99%

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Methotrexate‐associated EBV‐positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis

et al. 2016

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Rheumatoid vasculitis (RV) is one of the most serious extra-articular complications of rheumatoid arthritis (RA), generally treated with a high dose of immunosuppressive drugs. Recently, we encountered two cases of ulcerative vasculitis in methotrexate (MTX)-prescribed RA patients, which simulated RV; however, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization on their skin biopsies revealed many EBV-positive lymphocytes (over 50 cells/high-power field) within the vessel walls and perivascular stroma, which led us to the diagnosis of EBV-related vasculitis instead of RV. Subsequently, both ulcers regressed after the discontinuation of MTX and no recurrence was noted during the follow-up period. To prevent unnecessary treatment, EBV-positive vasculitis should be added in the differential diagnosis of lymphocytic vasculitis observed in MTX-administered RA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Methotrexate‐associated EBV‐positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis

et al. 2016

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“…5 The distinct histological features include a polymorphous infiltrate of small lymphocytes, histiocytes and plasma cells with frequently distributed atypical large B-cell blasts, often resembling Reed-Sternberg cell-like morphology, and intermediate-sized lymphoid cells, often associated with vasculitic changes. 6,7 The distinction between this and lymphoproliferative disorders can therefore be challenging. Immunohistochemically, however, they are characterised by variable CD20 expression but are positive for CD 30, MUM1, CD79a and EBV-LMP-1.…”

Section: Letters To the Editormentioning

confidence: 99%

“…5,6 All previous reported cases have achieved complete remission after withdrawal of immunosuppressive therapy or conservative management in the case of age-related immunosenescence. 7,8 ).…”

Section: Letters To the Editormentioning

confidence: 99%

“…between HMG-CoA reductase inhibitors and medications that either induce or inhibit, or are metabolised by the cytochrome P450 system are well known. 7 However, as rosuvastatin is mostly cleared by the kidneys unchanged and only less than 10% is metabolised by CYP2C9 and CYP2C19, drug interactions due to CYP system would appear less likely in this case. Furthermore, as carbamazepine is an inducer of CYP2C9 and CYP2C19, one would expect a reduction in the serum concentrations of rosuvastatin.…”

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confidence: 91%

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Fatal outcome of an Epstein–Barr virus positive mucocutaneous ulcer secondary to methotrexate

Nakauyaca

Kalro

Donaldson

et al. 2016

Internal Medicine Journal

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EBV-positive Mucocutaneous Ulcer With Small Lymphocytic Infiltration Mimicking Nonspecific Ulceration

Fujimoto¹,

Kaku

Hirata³

et al. 2021

American Journal of Surgical Pathology

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Epstein-Barr virus (EBV)-associated lymphoproliferative disorder may resemble nonspecific inflammation. We report 3 cases of immunosuppressed adult patients with small lymphocytic EBV ulcers in the skin and oral mucosa, characterized by a lack of atypical lymphocytic infiltration. All 3 cases were diagnosed in routine practice. For comparisons, cases of conventional Epstein-Barr virus–positive mucocutaneous ulcer (EBVMCU) were reviewed which were extracted from our pathology archives (n=11). The present patients were 2 females and 1 male, aged above 70 years. The primary disease was rheumatoid arthritis (n=2) and dermatitis herpetiformis (n=1). The main source of immunosuppression was prednisolone (n=2) and methotrexate (n=1). The ulcers were located in the oral cavity, buttock, and/or external genitalia. Histology evaluation revealed nonspecific lymphocytic infiltration. Epstein-Barr virus–encoded small RNA (EBER)-positive cells were small and coexpressed CD20. The number of EBER-positive cells ranged from 52 to 132/HPF, which was within the range of that observed in the reviewed conventional EBVMCUs (range, 48 to 1328; median, 121). All 3 cases regressed spontaneously or by the reduction of immunosuppressants. Although the present cases lacked cytologic atypia, those clinical course and loads of EBER-positive cells (>50/HPF) suggested EBV involvement. Current cases of EBVMCU with small lymphocytic infiltration underscore the need for EBER in situ hybridization when an etiology of ulcer with predominant lymphocytes in an immunosuppressed patient is unclear.

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Epstein–Barr virus‐encoded RNA in‐situ hybridization on non‐specific ulcerative skin lesions of immunosuppressed patients

Cited by 4 publications

References 4 publications

Methotrexate‐associated EBV‐positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis

Methotrexate‐associated EBV‐positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis

Fatal outcome of an Epstein–Barr virus positive mucocutaneous ulcer secondary to methotrexate

EBV-positive Mucocutaneous Ulcer With Small Lymphocytic Infiltration Mimicking Nonspecific Ulceration

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