Macules and verrucous lesions erupting in a pediatric transplant patient

AEV is reported in persons with HIV/AIDS and in solid organ transplant recipients on immunomodulatory medications. 1,2 A, Hypopigmented to light pink macules, some with overlying fine scale (arrowheads); B, Flat‐topped pink papules coalescing into plaques (arrowheads); C, Representative hematoxylin and eosin (H&E) staining of the two biopsy specimens, ×40 In AEV, depressed cell‐mediated immunity results in increased susceptibility to otherwise nonpathogenic β‐HPV types, most commonly 5 and 8. Many patients with IEV develop squamous cell carcinoma (SCC) by age 30, however, the risk is not as well characterized in AEV. 3,4 Further, determination of EV‐associated risk is complicated by known increased risk of malignancy, particularly SCC, in solid organ transplant recipients. 3,4 This patient highlights the unique challenge of treating AEV in pediatric transplant patients, which requires ruling out IEV, reducing/changing immunosuppressive medications, trial of therapies with varied reported efficacies, and counseling on increased risk of SCC. The lead author (Jacqueline S. Stevens) and corresponding author (Vernon J. Forrester) had full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis.