Abstract

Solid organ transplants and immunosuppression significantly increase the risk of lymphoma compared to the general population. Herein, we present a case of a 55-year-old renal transplant recipient with a history of lymphomatoid papulosis who presented with erythematous papules on the foot as well as an annular pink plaque on the thigh. Punch biopsy from the foot revealed a an infiltrate composed of large, atypical mononuclear cells positive for the CD30, consistent with a CD30-positive lymphoproliferative disorder (LPD).  A separate punch biopsy of the thigh demonstrated a dense superficial and deep perivascular and periadnexal lymphocytic infiltrate composed of small and medium size cells with numerous admixed plasma cells. Immunohistochemistry for CD20 and PAX-5 highlighted neoplastic B cells, CD138 was postive within plasma cells, and CD3 highlighted a background reactive T cell population; CD30 was negative. In situ hybridization demonstrated a monotypic plasma cell population with kappa restriction; these plasma cells expressed IgM. These findings were consistent with cutaneous marginal zone lymphoma. PET CT scan was negative for systemic disease. This case illustrates concurrent B- and T-cell lymphoproliferative disorders in the setting of immunosuppression: CD30 positive LPD and cutaneous marginal zone lymphoma.