Brigitte Balme MD

Brigitte Balme MD
CHLS Lyon France

Muco-cutaneous Ulceration Associated with EBV in the Setting of immunosuppression with methotrexate
Author: Brigitte Balme

Herein, we report a case of a 74 years old lady suffering from Rheumatoid Polyarthritis and thus treated by Methothrexate since 2008.
In October 2018, her hairdresser observed an asymptomatic purple plaque on the vertex. The lesion rapidly grew in to a 4cm ulcerated nodule.
A skin biopsy of the lesion was therefore performed. It showed diffuse infiltration of the dermis and hypodermis by large immunoblasts. The lesion was ulcerated. There was obvious necrosis in the lesion due to the angiocentrism iof the nfiltrate and vascular thrombosis.
The immunoblasts were B cells expressing CD20+, PAX5+, OCT2+), CD30+. We noted an Eber expression of RNA using the Fish technique. The ki67 proliferation index was about 70%. The PCR techniques demonstrated a rearrangement of kappa B and gamma T gene receptor .
We thereby proposed the diagnosis of muco-cutaneous ulceration associated with EBV in the setting of iatrogen immunosuppression with methotrexate.
It is a new entity described first in 2018 (OMS).
The lesion regressed completely when the treatment was discontinued.

Short CV

Pathology Unit, Centre Hospitalier Lyon
Doctor es Medecine in 1980 (University of LYON France)
Certificat d’études spécialisées de dermatologie (national board) in 1979
Certificat d’études spécialisées d’anatomie pathologie (national board) in 1983.

Member of the French Society of Dermatology
Member of the section of dermatopathology of the French Society of Pathology
Member of the International Society of Dermatopathology
Since 1980 médecin attaché des Hôpitaux
Since 1996, Praticien Hospitalier et since 2018, praticien hospitailer contractuel (department of dermatopathology, service of pathology, Pr M. Devouassoux, CHLS, Centre hospitalier Lyon Sud, 69415, PIERRE BENITE France).

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