Plasmablastic Lymphoma Presenting With Multiple Cutaneous Nodules Mimicking Primary Cutaneous Marginal Zone Lymphoma

Plasmablastic lymphoma (PBL) is a rare, high-grade large B-cell lymphoma characterized by large atypical cells with plasmablastic or immunoblastic morphology and a terminal B-cell differentiation phenotype. PBL often occurs in patients with immune deficiency or dysregulation, most commonly HIV infection. Cutaneous involvement is rare and occurs most frequently in those with immune deficiency. We report a 73-year-old immunocompetent female presenting with multiple cutaneous lesions and cervical lymphadenopathy. Nasopharyngeal and cutaneous biopsies confirmed EBV-associated PBL with plasmacytic differentiation, mimicking primary cutaneous marginal zone lymphoma (PC-MZL). The patient was treated with multiagent chemotherapy. Her disease progressed and she passed away in 9 months. We reviewed the literature for EBV-associated PBL occurring in the skin and those in immunocompetent patients. A comprehensive systemic evaluation integrating clinical, laboratory, and imaging findings is essential for excluding PC-MZL and plasmablastic multiple myeloma and establishing the correct diagnosis.