Mycosis Fungoides Presenting As A Pigmented Purpuric Dermatosis in A Renal Transplanted Patient - Mycosis Fungoides Presenting As A Pigmented Purpuric Dermatosis in A Renal Transplanted Patient - Open Access Pub

Cutaneous lymphoma after organ transplantation is rare and its diagnosis may be delayed by both atypical clinical manifestations and failure to consider it in the differential diagnosis. Beside skin-directed therapy for the stage, immunosuppression reduction is also important for disease control. We describe a clinical case of mycosis fungoides after renal transplantation and discuss the therapeutic options. DOI10.14302/issn.2576-9359.jot-17-1597 Mycosis fungoides in organ transplantated recipients is rare, since most post-transplant lymphoproliferative disorders are of B cell origin and associated with Epstein-Barr viral infections1,2. Immunosupression is the other important trigger for the onset of these lymphomas, especially in patients that are over-immunosuppressed3. A 50 years-old Caucasian man was referred to our outpatient clinic with a two months history of mildly pruritic red-brown patches on his lower limbs (Figure 1). He had had a kidney transplant seven years before, with unknown cause of renal failure and was medicated with tacrolimus 2 mg bid, prednisolone 5 mg and mychophenolate mofetil 500 mg bid. Figure 1. Red-brown patches on the lower limbs. Two skin biopsies were performed, with the diagnosis of pigmented purpuric dermatosis.The patient was then treated with topical mid potency corticosteroid with resolution of pruritus and partial regression of the lesions. Two years later, patches appeared on his upper limbs (Figure 2) and plaques on his lower limbs and the patient reported worsening of the pruritus. Figure 2. Red-brown patches and papules on the upper limbs. A skin biopsy revealed a dense pleomorphic lymphoid infiltrate in the superficial dermis (Figure 3) and epidermotropism. Immunohistochemistry showed a T-cell phenotype, positive for CD3, CD4, CD5 and negative for CD20. Figure 3. The skin biopsy revealed a dense pleomorphic lymphoid infiltrate in the superficial dermis and epidermotropism (HEx40) Mycosis fungoides, stage IB, was then diagnosed since blood counts, serum chemistries and CT scan of abdomen and chest were all normal The patient started high potency topical corticosteroids and, after consultation with the nephrologist, the dose of tacrolimus was halved. After 6 months follow-up, regression of the plaques and pruritus remission was obtained, without renal function deterioration and at three years follow up a good control of the disease was obtained, only with topical corticosteroids as needed. Mycosis fungoides is the most frequent form of cutaneous T-cell lymphoma in organ transplanted recipients2 with an average