Lupus Miliaris Disseminatus Faciei with Extrafacial Involvement

Vol. 28, No. 6, 2016 791 Received October 19, 2015, Revised November 18, 2015, Accepted for publication November 20, 2015 Corresponding author: Ji-Hye Park, Department of Dermatology, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-3549, Fax: 82-2-3410-3869, E-mail: [email protected] This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology thigh (Fig. 1B). A skin biopsy revealed nodular infiltration of polymorphic cells in dermis, but this time the tumor cells were positive for CD20, PAX5, BCL-2, and EBV, but negative for CD3 and CD45RO (Fig. 2D∼F). Three months after diagnosis of EBV-associated DLBCL of the skin, the patient died of respiratory failure caused by severe pneumonia. To date, only two cases of cutaneous EBV-associated DLBCL in patients with AITL have been reported. In both reports, initial AITL was EBV-positive using special staining. Therefore, our case is the first report of cutaneous DLBCL originating from AITL, in which the initial AITL was EBV-negative. Cases of both subsequent and concurrent developments of DLBCL in AITL have been reported, but only limited to journals of pathology. Some of these cases showed absence of EBV infection in biopsy specimen of initial AITL, shedding light on some other possible etiologic factors of secondary lymphoma development. However, despite the absence of EBV-infected B-cells in the initial biopsy specimen of our present case, EBV infection was found by PCR testing of a blood sample. This suggests the importance of testing for EBV infection even when the initial AITL biopsy specimen does not yield EBV positivity. Our case adds clinical evidence that EBV infection could be the culprit of DLBCL development in AITL patients, and suggests that the detection of EBV infection using PCR on a blood sample can be a more sensitive tool than EBV staining of biopsy specimen.