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Naito A, Kogame T, Kambe N, Kabashima K. A case of post herpes zoster granulomatous dermatitis successfully treated with UVA1 phototherapy. J Dermatol 2024; 51:e118-e119. [PMID: 37905586 DOI: 10.1111/1346-8138.17016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Atsushi Naito
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshiaki Kogame
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naotomo Kambe
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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2
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Hetzel JD, Diamond DC, Ramsey ZC, Henson JW, Powell MR. Postherpetic granulomatous dermatitis occurring in the setting of immune checkpoint inhibitor therapy: A case report. J Cutan Pathol 2024; 51:30-33. [PMID: 37589212 DOI: 10.1111/cup.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
We report a case of a 72-year-old man presenting with a 2-month history of a persistent, painful rash of the chest, axilla, and back. He had a history of recently resolved varicella zoster virus reactivation in the same distribution of the current rash and metastatic malignant melanoma treated with nivolumab and ipilimumab. The histopathology was consistent with granulomatous dermatitis (GD), and a diagnosis of postherpetic isotopic response manifesting as GD was made. Given the paucity of reported cases of postherpetic GD in the setting of treatment with immune checkpoint inhibitors (ICIs), we discuss the clinicopathologic features of this case and potential mechanisms by which ICIs may contribute to the development of granulomatous disease.
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Affiliation(s)
- John D Hetzel
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Davis C Diamond
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Zachary C Ramsey
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - John W Henson
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
- Heme/Onc Division, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Matthew R Powell
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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3
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Tripathy DM, Kumar S, Saraswat N, Goel S, Ranjan E. Post herpetic granulomatous dermatitis and herpes zoster necroticans triggered by Covid-19 vaccination. Dermatol Ther 2022; 35:e15707. [PMID: 35811450 PMCID: PMC9350396 DOI: 10.1111/dth.15707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/18/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sushil Kumar
- Dermatology, Motilal Nehru Medical College, Allahabad, India
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4
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Carter ZA, Wu SZ, Spicknall KE, Knabel PM. Practice Highlight: Postzoster Perineural Inflammation Mimicking Perineural Invasion During Mohs Micrographic Surgery. Dermatol Surg 2022; 48:358-360. [PMID: 34999603 DOI: 10.1097/dss.0000000000003306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Zachary A Carter
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
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5
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Yoon JH, Jang YJ, Park EJ, Kim KJ, Kim KH. A Case of Herpes Zoster Granulomatous Dermatitis: Report of Wolf's Isotopic Response. Ann Dermatol 2021; 33:186-189. [PMID: 33935462 PMCID: PMC8081995 DOI: 10.5021/ad.2021.33.2.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
Wolf's isotopic response refers to the occurrence of a novel skin disease at the site of a preceding treated or untreated skin disease. Although the most common preceding skin disease was found to be herpes zoster (HZ), HZ-related dermatological phenomena are not well known in the literature. We report a case of HZ granulomatous dermatitis in a 77-year-old female with a previous history of hypertension, diabetes mellitus, chronic kidney disease, and HZ. She presented with a 3-month history of a pruritic skin lesion on her right thigh. The location of the lesion was consistent with a previous HZ site. Histopathological examination revealed lympho- histiocytic infiltration in the superficial dermis, forming a granulomatous structure. Based on clinical and histopathological findings, we made a diagnosis of granulomatous dermatitis at a previous HZ site. We assumed that the lesion arose from an isotopic response of Wolf. The patient was treated with topical steroids for 3 months and showed clearance of the lesion and symptom. We suggest that treatment should be based on the individual disease, which in our case was topical steroid.
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Affiliation(s)
- Ji Ha Yoon
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ye Ji Jang
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
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6
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Spectrum of Clinicopathologic Findings in COVID-19-induced Skin Lesions: Demonstration of Direct Viral Infection of the Endothelial Cells. Am J Surg Pathol 2021; 45:293-303. [PMID: 33399338 DOI: 10.1097/pas.0000000000001634] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The novel coronavirus disease (COVID-19) is a rapidly spreading pandemic, secondary to severe acute respiratory syndrome coronavirus 2. The severity and the little knowledge that we have of the disease have made us focus mostly on the respiratory symptoms. As we bend the curve, other findings reported in association with COVID-19 become of importance for specialists to recognize. We describe the spectrum of clinicopathologic lesions in the skin that can be the only symptom or the first manifestation of COVID-19 and demonstrate the origin of the virus. We collected 25 patients with skin lesions in this context. We recognized 5 types of cutaneous manifestations including acute acroischemic or chilblain-like lesions (11), purpura palpable (2), exanthemas (9), urticarial eruptions (1), and other lesions (2) that might appear with more unspecific pictures. Chilblain-like lesions were the most common form of presentation, which tend to appear as self-healing, erythematous-necrotic plaques mostly on the feet, in young patients with no systemic symptoms associated. Importantly, we visualized viral particles with electron microscopy in 5 of 13 cases analyzed. In this study, we seek to draw a picture of the spectrum of clinicopathologic lesions that may appear in the skin in the context of COVID-19. Although apparently skin lesions are not correlated with disease severity, it may help in some cases to recognize and control the spread of the infection sooner.
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7
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Swali R, Wiggins C, Tyring SK. Hyperkeratosis of the left cheek. Proc (Bayl Univ Med Cent) 2020; 33:592-593. [DOI: 10.1080/08998280.2020.1775481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ritu Swali
- Center for Clinical Studies, Houston, Texas
| | - Claire Wiggins
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Stephen K. Tyring
- Center for Clinical Studies, Houston, Texas
- Department of Dermatology, McGovern Medical School, UT Houston Health Science Center, Houston, Texas
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8
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Lehman JS, Sokumbi O, Peters MS, Bridges AG, Comfere NI, Gibson LE, Wieland CN. Histopathologic features of noninfectious granulomatous disorders involving the skin. Hum Pathol 2020; 103:127-145. [PMID: 32544405 DOI: 10.1016/j.humpath.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/31/2020] [Indexed: 11/17/2022]
Abstract
Granulomatous dermatoses may represent primary skin inflammation or can serve as the harbinger of a multitude of underlying systemic disorders or drug reactions. Taken together with clinical findings, the microscopic features from skin biopsy can allow recognition of various patterns and facilitate a precise diagnosis. Accurate classification of entities in this category of inflammatory dermatoses may prompt clinicians to investigate for underlying systemic problems, thereby allowing the pathologist to add considerable value in the care of affected patients. This review article categorizes clinical and microscopic features of common and uncommon causes of noninfectious dermal and subcutaneous granulomatous inflammation.
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Affiliation(s)
- Julia S Lehman
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Margot S Peters
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alina G Bridges
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lawrence E Gibson
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
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9
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Gozzi E, Rossi L, Angelini F, Leoni V, Trenta P, Cimino G, Tomao S. Herpes zoster granulomatous dermatitis in metastatic lung cancer treated with nivolumab: A case report. Thorac Cancer 2020; 11:1330-1333. [PMID: 32141197 PMCID: PMC7180604 DOI: 10.1111/1759-7714.13377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 11/28/2022] Open
Abstract
Granulomatous dermatitis (GD) is the most common among a variety of skin reactions that may occur in the varicella‐zoster virus (VZV) reactivation area. It is thought that the formation of granulomas may be the result of a delayed hypersensitivity reaction to viral envelope glycoproteins. Immune checkpoint inhibitors (ICIs), such as nivolumab stimulate T cells and promote hypersensitivity reactions, leading to the formation of granulomas in VZV wrapping proteins, thus triggering VZV‐GD. Few cases of the use of ICIs in patients diagnosed with VZV‐GD have been reported in the literature. Here, we report the clinical case of a patient with metastatic lung cancer which was treated with nivolumab who subsequently developed VZV‐GD. Accurate clinical diagnosis and prompt treatment with antiviral agents have resulted in a complete resolution of the clinical picture. Key points What this study adds Few cases of ICI and VZV reactivation have been reported in the literature. Full and timely resolution of VZV‐GD allowed the continuation of ICI treatment.
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Affiliation(s)
- Elisa Gozzi
- UOC of Oncology - ASL Latina- Distretto 1, University of Rome "Sapienza," via Giustiniano snc - 04011, Aprilia, Italy
| | - Luigi Rossi
- UOC of Oncology - ASL Latina- Distretto 1, University of Rome "Sapienza," via Giustiniano snc - 04011, Aprilia, Italy
| | | | - Valentina Leoni
- Medical Oncology Unit, Regina Apostolorum Hospital, Rome, Italy
| | - Patrizia Trenta
- Medical Oncology Unit, Regina Apostolorum Hospital, Rome, Italy
| | - Giuseppe Cimino
- Department of Medical Oncology, Sapienza University of Rome, Medical and Surgical Sciences and Biotechnology, Rome, Italy
| | - Silverio Tomao
- Division of Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Consorzio Interuniversitario per la Bio-Oncologia (CINBO), Chieti, Italy
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10
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Hochman E, Ferenczi K, Payette MJ. A peculiar dermatomal plaque. Int J Dermatol 2019; 58:1132-1134. [PMID: 30888044 DOI: 10.1111/ijd.14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Edward Hochman
- Department of Dermatology, UConn Health, Farmington, CT, USA
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11
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Abstract
Herpes zoster (HZ) is the result of reactivation of latent varicella zoster virus (VZV) and occurs most frequently in older adults. Classically, HZ presents as a unilateral, selflimited, dermatomal rash. Postherpetic neuralgia (PHN) is a common sequela, presenting as severe pain that persists after the rash has resolved. In the elderly, PHN can be debilitating and requires a prompt diagnosis, treatment with antivirals, and adequate pain control. A longer-term pain management strategy is required if PHN occurs. A modestly effective vaccine exists and is recommended for older individuals.
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12
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Everett AS, Pavlidakey PG, Contreras CM, De Los Santos JF, Kim JY, McKee SB, Kaufman HL, Conry RM. Chronic granulomatous dermatitis induced by talimogene laherparepvec therapy of melanoma metastases. J Cutan Pathol 2018; 45:48-53. [PMID: 28940544 DOI: 10.1111/cup.13048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/08/2017] [Accepted: 09/15/2017] [Indexed: 01/03/2023]
Abstract
Talimogene laherparepvec (TVEC) is the first oncolytic viral immunotherapy approved by the FDA, for advanced melanoma consisting of genetically modified herpes simplex type 1 virus which selectively replicates causing tumor lysis, expressing granulocyte macrophage-colony stimulating factor (GM-CSF) and activating dendritic cells. Intratumoral injection of TVEC produces objective response in 41% of stage IIB-IV M1a melanoma. However, clinical response assessment can be problematic due to immune-related inflammation at established tumor sites. Herein, we report 5 cases of granulomatous dermatitis developing at sites of TVEC injection associated with pathologic complete response in 4 of 5 patients. Over 5 months, TVEC injections were administrated in a median of 20 tumors per patient for 9 median doses prior to biopsy of persistent, indurated nodules. Granulomatous dermatitis with melanophages and melanin pigment incontinence was observed in all samples without evidence of melanoma cells in 4 patients. The fifth patient was rendered melanoma-free by resection of the 1 nodule out of 4 with persistent tumor. Repetitive administration of TVEC or other oncolytic viral immunotherapies mimicking unresolved infection can produce granulomatous inflammation confounding assessment of the degree of tumor response and need for additional TVEC therapy. Tumor biopsies are encouraged after 4 to 6 months of TVEC administration to differentiate melanoma from granulomatous inflammation. Patients with confirmed granulomatous dermatitis replace continued with remained in remission after treatment discontinuation. Inflammatory nodules typically regress spontaneously.
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Affiliation(s)
- Ashlyn S Everett
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter G Pavlidakey
- Dermatopathology Services, Division of Dermatology and Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlo M Contreras
- Department of Surgery - General Surgery Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Ju Y Kim
- Navigate BioPharma Services, Inc., A Novartis Subsidiary, Carlsbad, California
| | - Svetlana B McKee
- Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Howard L Kaufman
- Department of Surgery and Medicine, Rutgers University, New Brunswick, New Jersey
| | - Robert M Conry
- Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Postherpetic Granulomatous Dermatitis in a Man Treated With Nivolumab. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Martín-Carrasco P, Pérez-Ruiz C, de Zulueta-Dorado T, Conejo-Mir J. Postherpetic Granulomatous Dermatitis in a Man Treated With Nivolumab. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:783-784. [PMID: 28532783 DOI: 10.1016/j.ad.2017.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/02/2016] [Accepted: 02/05/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- P Martín-Carrasco
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - C Pérez-Ruiz
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - T de Zulueta-Dorado
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Conejo-Mir
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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15
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Motaparthi K. Palisaded granulomatous dermatitis secondary to recombinant insulin. J Cutan Pathol 2017; 44:509-511. [DOI: 10.1111/cup.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/16/2017] [Accepted: 01/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Kiran Motaparthi
- Department of Dermatology; University of Florida College of Medicine; Gainesville Florida
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Malviya N, Marzuka A, Maamed-Tayeb M, Le L, Vandergriff T. Cutaneous involvement of pre-existing Rosai-Dorfman disease via post-herpetic isotopic response. J Cutan Pathol 2016; 43:1211-1214. [PMID: 27611178 DOI: 10.1111/cup.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 11/29/2022]
Abstract
We report the case of a patient with a long-standing history of extranodal, sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and no evidence of original cutaneous involvement as well as a history of herpes zoster of the left flank with post-herpetic neuralgia who went on to develop multiple, round-to-oval, red-brown, atrophic macules and thin papules at the sites of herpes zoster scars on the left flank. Histopathology showed a dense nodular infiltrate of lymphocytes with some plasma cells and numerous large pale-staining histiocytes (S100+/CD68+), consistent with Rosai-Dorfman disease. This case showed exclusively cutaneous involvement, as demonstrated by otherwise normal physical examination, laboratory evaluation and imaging. This is the second reported case of Rosai-Dorfman disease occurring at the site of zoster scars, and to our knowledge this represents the first case report of cutaneous involvement of pre-existing Rosai-Dorfman disease via post-herpetic isotopic response (Wolf's isotopic response).
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Affiliation(s)
- Neeta Malviya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander Marzuka
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mokhtar Maamed-Tayeb
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lu Le
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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