Oral Malignant Acanthosis Nigricans and Tripe Palms Associated With Renal Urothelial Carcinoma

Abstract

had larger, irregularly shaped ulcerations with a fibrinous base on her legs.Blood and skin cultures grew MRSA that was sensitive to trimethoprim-sulfamethoxazole, vancomycin, linezolid, and daptomycin.Findings of polymerase chain reaction (PCR) studies of cutaneous ulcerations were negative for varicella zoster virus and HSV.A punch biopsy of a cutaneous ulcer revealed epidermal atrophy, papillary dermal edema, and perivascular and interstitial mixed inflammation.Scattered endothelial cells in small dermal vessels and dermal fibroblasts showed large eosinophilic intranuclear inclusions surrounded by a clear halo (Figure 2).Immunohistochemical stains for CMV highlighted several endothelial cells and fibroblasts (Figure 2, inset).No PCR testing for CMV was performed on skin specimens because the positive immunohistochemical findings were considered confirmatory.Cytomegalovirus DNA was detected by plasma PCR.She was diagnosed with disseminated cutaneous CMV infection with CMV viremia.There was no evidence of other organ involvement or of further progression of her MF or hematologic disease.Treatment with TBEB was discontinued, and she completed 3 weeks of treatment with intravenous ganciclovir and vancomycin followed by resolution of her cutaneous ulcerations.Subsequent plasma CMV PCR findings were negative, and she was discharged home.