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Epstein-Barr virus and polymorphic B-cell lymphoproliferative disorder: case report A 74-year-old man developed Epstein-Barr virus (EBV) and other iatrogenic immunodeficiency-associated lymphoproliferative disorders manifesting polymorphic B-cell lymphoproliferative disorder (LPD) during treatment with mycophenolate-mofetil for scleroderma [route and duration of treatment to reactions onsets not stated]. The man presented to the oral and maxillofacial surgery outpatient clinic for evaluating an ulcerative lesion in the right anterior maxilla. He had a history of scleroderma and had been receiving mycophenolate-mofetil 1000mg twice daily since three years. Clinical examination showed nonpurulent, nontender, ulcerative lesion in the right anterior maxilla with an exposed necrotic bone, which extended from the gingival margins of the right first premolar to the right lateral incisor, past the mucogingival junction at its greatest superior extent and involving the palatal gingival margin of the involve teeth. A cone-beam CT scan and panoramic radiograph did not show apparent radiographic osteolytic involvement of the underlying maxillary bone. Based on the ulcerative presentation of the lesion, differential diagnosis of oral squamous cell carcinoma, osteonecrosis of the jaw, acute necrotising ulcerative periodontitis and fungal/viral infection were considered. Initial biopsy results showed squamous mucosa with ulceration and granulation tissue. Thereafter, he underwent debridement of the lesion in the right anterior maxilla, and biopsy was done. Histopathology reports revealed a polymorphous infiltrate of macrophages, lymphocytes and plasma cells along with some ReedSternberg-like large cells. Immunohistochemical staining revealed some Reed-Sternberg-like cells were large B-cells positive for CD20, MUM1, and PAX5, indicators for B-cell lymphoblastic neoplasms, and negative for CD15, CD5 and CD10, which were suggestive against Mantle cell lymphoma. EBV by in-situ hybridisation stain showed positive in the large B-cells. Based on these findings a diagnosis was confirmed with EBV and polymorphic B-cell LPD. He was referred to the Hematology and Oncology Department for the management and evaluation of the LPD. A positron emission tomographic CT scan showed no systemic disease. Laboratory findings showed EBV IgM negative and EBV IgG positive, with low EBV DNA titer at 354 copies/mL. The man’s dose of mycophenolate-mofetil was reduced over the course of several months. At the 5 month follow-up, the maxillary surgical site was healed well with no evidence of disease recurrence. EBV titers were also found at undetectable levels. However, he was unable to take fluids orally due to the lip tethered to the maxillary alveolar ridge as a result of the advancement flap. Therefore, a postsurgical reconstruction was performed successfully with split thickness skin graft vestibuloplasty from the right anterior lateral thigh for relieving tension on the upper lip. At 6 month follow-up, he was found disease free with no evidence of