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Lymphoproliferative disorders arising in a background of immune deficiency/dysregulation correspond to a spectrum of disorders ranging from non-noxious hyperplasias to aggressive lymphomas, mainly of B-cell type. We describe a case of an Epstein-Barr virus-positive T-cell lymphoma, with a cutaneous presentation and unusual pathological features in a patient under immunosuppression with infliximab. A 60-year-old male, with a history of ankylosing spondylitis and autoimmune hemolytic anemia, treated with infliximab and low-dose prednisone since 2013, presented with a 7 cm ulcerated, well-demarcated tumor on his left lower back and a 20 cm scaly, well-demarcated erythematous patch in the left scapular region. A skin biopsy revealed a diffuse infiltration of the superficial and deep dermis by atypical, intermediate-size lymphocytes that expressed CD2, CD3, CD56, TIA-1, Granzyme B, TCRδ, and EBER. There was no evidence of epidermotropism, vasculotropism, or necrosis. The fluor-d-glucose positron emission tomography showed a large splenic, hepatic, bone marrow, and nodal uptake. A diagnosis of an extranodal NK/T-cell lymphoma in association with immunosuppression was rendered. With this article, we aim to add awareness to the difficulty of diagnosis, the careful use of immunomodulators, clinical suspiciousness, and surveillance of possible consequences warranted in all patients under prolonged immunosuppression.

Desmoid tumors are rare benign neoplasms, with locally aggressive characteristics. Ongoing or previous pregnancy, antecedent trauma, and familial adenomatous polyposis are known risk factors. Still, the majority of cases are sporadic and its etiology is still unknown. These tumors may occur in any body site, but retroperitoneal and pelvic desmoid tumors are extremely rare. Nonspecific clinical and radiological findings lead to erroneous diagnosis in 50% of patients before surgery. We present a case of a young multiparous female with a deep infiltrative lesion adherent to the right pelvic sidewall leading to severe right hydroureteronephrosis and ipsilateral loss of renal function. Although deep endometriosis was suspected, malignancy features could not be excluded by imaging studies. The patient underwent an exploratory laparotomy for definite diagnosis and treatment, which led to right nephrectomy, hysterectomy, and right oophorectomy because of deep infiltration and difficult dissection. Definite histologic diagnosis revealed the presence of a pelvic desmoid tumor. Positive margins were encountered but, until this moment, no disease relapse occurred.

We report a clinical case of a 39-year old male, without any known previous medical condition but with occupational exposure to paints and dust cement, who presented an autoimmune pulmonary alveolar proteinosis (PAP) triggered by exposure to toxic inhalation at his workplace. PAP is a rare lung disease characterized by intra-alveolar abnormal accumulation of surfactant. The presence of a crazy-paving pattern in high-resolution computed tomography scan brings the suspicion of PAP although histopathology results of bronchoalveolar lavage are always required for its final diagnosis. The autoimmune form of PAP due to toxic inhalation, such as the one here described, is rare and it is usually difficult to establish a causal relationship.