Facial ulceration in a renal transplant recipient

Abstract

A 60-year-old man presented with a 3-week history of a painless, eroded, nodular, lesion of the left inner canthus (Fig 1). His medical history included binephrectomy and renal transplantation 15 years ago, as well as the surgical excision of a nodular basal cell carcinoma (nBCC) of the same left inner canthus 6 years earlier. The immunosuppressive medication consisted of methylprednisolone (8 mg/day), everolimus, and mycophenolate mofetil. A 3-mm punch biopsy stained with hematoxylin/eosin (H/E) revealed a dense dermal lymphoid infiltrate surrounding the pilosebaceous appendages and composed of lymphocytes without notable atypia, associated with numerous plasma cells (Fig 2).