A woman in her early 60s presented with a 3-month history of progressive, pinkish brown, slightly keratotic, flat-topped papules involving the inner thighs (Figure, A). She had a history of double-lung transplantation for emphysema secondary to alpha1-antitrypsin deficiency and was chronically immunosuppressed with tacrolimus, azathioprine, and prednisone. A shave biopsy specimen was obtained (Figure, B). The patient subsequently developed eruptive, innumerable, fleshy, condylomatous perianal papules (Figure, C). A shave biopsy revealed histopathologic features very similar to those in Figure, A, except for the presence of a markedly papillomatous architecture.
Hoesly F, Cappel M. Flat-Topped and Condylomatous Papules in a Lung Transplant Patient. JAMA Dermatol. 2014;150(3):327-328. doi:10.1001/jamadermatol.2013.6332