Flat-Topped and Condylomatous Papules in a Lung Transplant Patient

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.