New Clinicopathological Findings in a Patient with Face Allotransplantation

During the follow-up the recipient developed primary asymptomatic EBV infection, followed by EBVC B-cell lymphoma and hepatic leiomyosarcoma, for which the immunosuppressive treatment was greatly reduced. During the first post-transplant year, acute rejection (AR) episodes were completely reversed with steroids. Subsequently, several episodes of AR occurred that were difficult to reverse with steroids and Campath-1; they manifested clinically with graft erythema and histologically with lichenoid changes of the epidermis and appendages. Since the second post-transplant year the allografted facial skin became progressively sclerotic and presented pigmented macules on a background of hypopigmentation and telangiectases, realizing a poikilodermatous aspect. Skin biopsies showed epidermal atrophy, basal cell vacuolization and diffuse dermal sclerosis. In the superficial dermis there were rare CD3C and CD4C lymphocytes and in the deep dermis few TIAC1 cytotoxic lymphocytes. The large vessels seemed unaffected while dermal capillaries showed thickened walls and narrowed lumina. Donor specific anti-HLA class II antibodies were detected transiently in January 2010.