Pulmonary and cutaneous nodules in an immunocompromised patient

Abstract

A 74-year-old man was admitted to hospital due to dyspnoea, malaise and purple, plaque-like papular nodules on his hands (figure 1A), soles (figure 1B) and genitalia for a duration of 1 month. He reported a 5-month history of systemic corticosteroid use for treatment of giant cell arteritis. Laboratory tests disclosed severe lymphopenia and hypogammaglobulinaemia. Pancultures and serological tests were negative, including repeated HIV serology. Contrast-enhanced CT of the chest (2.5 mm slice thickness) demonstrated multiple bilateral solid pulmonary nodules with peribronchovascular distribution and a cavitating nodule in the left lower lobe ( figure 1C). Abdominal CT revealed multiple hepatic ring-enhancing lesions ( figure 1D). A bronchoscopy for inspection, bronchoalveolar lavage and transbronchial biopsies was discussed but deemed difficult to be performed safely due to the worsening respiratory status of the patient. Contributors PJV and SK treated the patient and drafted the article. KK critically revised the manuscript. QUESTIONProvenance and peer review Not commissioned; externally peer reviewed.

Pulmonary Epstein–Barr virus-associated smooth muscle tumor after kidney transplantation: two case reports with review of differential diagnosis

“…Combining its microscopic morphology, the use of lymphocyte-associated IHC markers like CD3, CD20, and EBER ISH, leads to a definitive diagnosis. Kaposi’s sarcoma is another complication caused by immunosuppressants, and in rare cases it may present as multiple bilateral solid pulmonary nodules [ 27 , 28 ]. Classic purple, plaque-like papular nodules might be observed on the skin during examination [ 28 ].…”

“…Kaposi’s sarcoma is another complication caused by immunosuppressants, and in rare cases it may present as multiple bilateral solid pulmonary nodules [ 27 , 28 ]. Classic purple, plaque-like papular nodules might be observed on the skin during examination [ 28 ]. The histological characteristics of this tumor include proliferation of oval/spindle cells surrounding vessels, accompanied by infiltration of lympho-plasmacytes and extravasation of erythrocytes.…”