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Moreau CMM, Del Pozo Hernando LJ. Reverse Isotopic Phenomenon in Acute Drug Eruption. Dermatol Pract Concept 2024; 14:dpc.1401a55. [PMID: 38364423 PMCID: PMC10868955 DOI: 10.5826/dpc.1401a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 02/18/2024] Open
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[Translated article] Leukemia Cutis Mimicking Granulomatous Rosacea at the Onset of Chronic Lymphocytic Leukemia. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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3
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Vázquez-Osorio I, Chamorro-Chamorro P, Gonzalvo-Rodríguez P, Rodríguez-Díaz E. Leucemia cutis simulando una rosácea granulomatosa: presentación clínica de una leucemia linfoide crónica. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:326-328. [DOI: 10.1016/j.ad.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/28/2020] [Accepted: 03/26/2020] [Indexed: 11/29/2022] Open
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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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Atypical Herpes Simplex Presenting Necrotizing Granulomas in an Immunocompromised Patient. Am J Dermatopathol 2020; 42:305-306. [PMID: 31188142 DOI: 10.1097/dad.0000000000001462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Munir S, Abu-Jubara D, Abu-Jubara M, Antypas C, Petro-Sakuma C. A New Skin Manifestation at the Site of a Previously Healed Dermatosis: A Case of Wolf's Isotopic Response. Cureus 2020; 12:e11381. [PMID: 33312782 PMCID: PMC7723431 DOI: 10.7759/cureus.11381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Wolf's isotopic response (WIR) is an uncommon phenomenon that refers to the occurrence of a new skin condition at the location of a previously healed dermatosis. We describe an unusual manifestation of bacterial furunculosis which arose as an isotopic response following a herpes zoster episode. The initial skin disease in most cases is herpes zoster and the isotopic response is a granulomatous reaction. A 65-year-old female with a history of chronic lymphocytic leukemia (CLL) and currently on chemotherapy regimen presented with a pustular skin rash on the posterior scalp extending to the posterior right neck and shoulder. Prior to this presentation, the patient was treated for three weeks with valacyclovir for herpes zoster infection which improved her skin condition. During the current hospitalization, the patient's wound cultures from the pustule revealed the growth of methicillin-resistant Staphylococcus aureus (MRSA). Although the patient was on immunosuppressive therapy, her white blood cell (WBC) count increased to 9.9 x 103/μL. After receiving vancomycin and valacyclovir, her cutaneous condition eventually improved. She was transitioned to oral clindamycin and discharged to a rehabilitation facility. This case describes an immunocompromised patient who was treated for herpes zoster, improved after treatment, and then developed MRSA furunculosis at the same site. It is of significance to report such manifestations, especially in immunocompromised patients, as it could be underdiagnosed. It is also important to inquire about the patients' herpes-related medical history because herpes is the most common initial dermatosis reported in the literature. In such cases of suspected WIR, it is vital to obtain a biopsy before starting treatment with antiviral medication to rule out the possibility of malignancy.
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Affiliation(s)
- Syed Munir
- Internal Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Dania Abu-Jubara
- Emergency Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Musa Abu-Jubara
- Internal Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
| | - Carla Antypas
- Family Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA
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Tabosa GVBS, Stelini RF, Souza EM, Velho PENF, Cintra ML, Florence MEB. Immunocompromised cutaneous district, isotopic, and isopathic phenomena-Systematic review. J Cosmet Dermatol 2020; 20:410-416. [PMID: 32629542 DOI: 10.1111/jocd.13592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the development of lesions in skin areas that have undergone injury has long been known, understanding of its pathogenesis is limited. Depending on their peculiarities, those events have been described as isomorphic, reverse isomorphic, pseudoisomorphic, isotopic, and isopathic phenomena. Ruocco's immunocompromised cutaneous district (ICD) concept was proposed to include all those phenomena. AIMS We performed a systematic review and critically evaluated the current understanding about ICD and its relationship with the isotopic and isopathic phenomena. METHODS To illustrate the complexity of the theme, we present a case of subclinical leprosy, whose manifestation was brisk in an old tattoo. The possible interaction between the approached phenomena, acting in the genesis of the disease, made this a pertinent study. The research was conducted under the PRISMA-P guidelines, in seven biomedical databases between 1996 and 2018. The eligibility criteria were systematic reviews, meta-analyses, clinical studies, and case series, written in English, French, Italian, Portuguese, or Spanish. RESULTS Using standardized keywords, 1220 articles were identified. After applying the eligibility criteria, 53 studies were selected. CONCLUSION This review ratifies that all these phenomena are aspects of one single condition. They can be integrated into the ICD concept with the pathogenesis including: (a) neural damage (peripheral or central) and (b) chronic lymphedema. Both may change the local neuroimmune interaction. The identification of these phenomena and the understanding of their pathogenesis are of paramount importance, to define the diagnosis and choose the therapeutic strategy.
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Affiliation(s)
| | - Rafael F Stelini
- Department of Pathology, Medical Sciences School, Unicamp, Campinas, Brazil
| | - Elemir M Souza
- Department of Dermatology, Medical Sciences School, Unicamp, Campinas, Brazil
| | - Paulo E N F Velho
- Department of Dermatology, Medical Sciences School, Unicamp, Campinas, Brazil
| | - Maria L Cintra
- Department of Pathology, Medical Sciences School, Unicamp, Campinas, Brazil
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Wollina U, Schönlebe J, Hansel G, Koch A. First case of primary diffuse large B-cell lymphoma of skin as Wolf's postherpetic isotopic response. Dermatol Ther 2020; 33:e13714. [PMID: 32472587 DOI: 10.1111/dth.13714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Jacqueline Schönlebe
- Institute of Pathology "Georg Schmorl," Städtisches Klinikum Dresden, Dresden, Germany
| | - Gesina Hansel
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - André Koch
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
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Bostan E, Gulseren D, Gokoz O, Orhan D, Aytac S, Ersoy-Evans S. Deep fungal infection at the sites of previous insect bites. J Cosmet Dermatol 2020; 20:366-367. [PMID: 32333522 DOI: 10.1111/jocd.13433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ecem Bostan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Duygu Gulseren
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ozay Gokoz
- Department of Pathology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Selin Aytac
- Department of Pediatric Hematology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sibel Ersoy-Evans
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
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Szlávicz E, Kálmán E, Gyömörei C, Kovács LA, Ócsai H, Varga E, Oláh J, Gyulai R, Lengyel Z. Presence of varicella zoster virus in zosteriform leukaemia cutis. Clin Exp Dermatol 2019; 44:e200-e204. [PMID: 30628105 DOI: 10.1111/ced.13899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 12/01/2022]
Abstract
Leukaemia cutis is a relatively rare manifestation in chronic lymphocytic leukaemia, characterized by a diverse morphology of skin lesions. We report two patients who developed zosteriform skin symptoms; however, the histological analysis revealed leukaemia infiltration as the cause of their symptoms. Contrary to previous reports, varicella zoster virus DNA was detectable in the lesions. These findings suggest that varicella zoster virus plays an active role in the development of zosteriform leukaemia cutis.
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Affiliation(s)
- E Szlávicz
- Department of Dermatology, Venereology and Oncodermatology, University of Pecs, Pecs, Hungary
| | - E Kálmán
- Department of Dermatology, Venereology and Oncodermatology, University of Pecs, Pecs, Hungary
| | - C Gyömörei
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - L A Kovács
- Department of Dermatology, Venereology and Oncodermatology, University of Pecs, Pecs, Hungary
| | - H Ócsai
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - E Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - J Oláh
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - R Gyulai
- Department of Dermatology, Venereology and Oncodermatology, University of Pecs, Pecs, Hungary
| | - Z Lengyel
- Department of Dermatology, Venereology and Oncodermatology, University of Pecs, Pecs, Hungary
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Brasileiro A, Lencastre A, João A, Fidalgo A. Cutaneous leukemic infiltration following varicella - a case of Wolf's isotopic response. An Bras Dermatol 2017; 91:72-75. [PMID: 28300900 PMCID: PMC5324999 DOI: 10.1590/abd1806-4841.20164686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/14/2015] [Indexed: 11/22/2022] Open
Abstract
Wolf's isotopic response designates the appearance of two subsequent unrelated dermatoses in the same anatomic location. We report the case of a 51-year-old man with a medical history of chronic lymphocytic leukemia without known extra-hematopoietic involvement. The patient developed a disseminated papulo-vesiculous eruption, diagnosed as varicella. Few days after recovering, an erythematous and violaceous papular dermatosis with histopathological examination compatible with leukemic infiltration appeared on the scars of previous herpetic lesions. Complete remission was obtained under systemic corticotherapy, without cutaneous recurrence or blastic transformation. Wolf's isotopic response is attributed to a localized immunologic imbalance following a certain stimulus. In this patient, herpetic infection acted as a local spur for inaugural cutaneous leukemic infiltration, with no impact on the prognosis for the underlying disease.
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Affiliation(s)
- Ana Brasileiro
- Hospital S. António Capuchos - Centro Hospitalar Lisboa Central - Lisbon, Portugal
| | - André Lencastre
- Hospital S. António Capuchos - Centro Hospitalar Lisboa Central - Lisbon, Portugal
| | - Alexandre João
- Hospital S. António Capuchos - Centro Hospitalar Lisboa Central - Lisbon, Portugal
| | - Ana Fidalgo
- Hospital S. António Capuchos - Centro Hospitalar Lisboa Central - Lisbon, Portugal
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McDonald HH, Corsini LM, Siddiqui HA, Kowalewski C. Granulomatous Reaction After Complete Resolution of Primary Varicella. Am J Dermatopathol 2017; 40:49-51. [PMID: 28406799 DOI: 10.1097/dad.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Heidi H McDonald
- Division of Dermatology and Cutaneous Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Laura M Corsini
- Division of Dermatology and Cutaneous Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Huma A Siddiqui
- Department of Pathology, Audie L. Murphy VA Medical Center, San Antonio, TX
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Lichen Nitidus Arising on Vitiligo: A New Variant of the Isotopic Coresponse. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Zosteriform Morphea Without History of Herpes Zoster Infection. Arch Rheumatol 2016; 31:390-392. [PMID: 30375569 DOI: 10.5606/archrheumatol.2017.5902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/23/2016] [Indexed: 11/21/2022] Open
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Oscoz-Jaime S, Loidi-Pascual L, Tuñón-Álvarez MT, Yanguas-Bayona JI. Lichen Nitidus Arising on Vitiligo: A New Variant of the Isotopic Coresponse. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:860-861. [PMID: 27372544 DOI: 10.1016/j.ad.2016.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/11/2016] [Accepted: 05/29/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- S Oscoz-Jaime
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - L Loidi-Pascual
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M T Tuñón-Álvarez
- Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - J I Yanguas-Bayona
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Queiroz MTDS, Almeida JRPD, Sementilli Â, Mattos e Dinato SL, Romiti N. Wolf's isotopic response, presenting as lichen planus. An Bras Dermatol 2016; 90:91-3. [PMID: 26312684 PMCID: PMC4540518 DOI: 10.1590/abd1806-4841.20153763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022] Open
Abstract
The term "Wolf's isotopic response" describes the occurrence of a new skin disorder at the site of another unrelated and already healed skin disease. In most cases, herpes zoster is the inicial disease. Different disorders may develop on the same site, most commonly granulomatous and lichenoid reactions, infiltration of hematologic diseases, skin tumors and infections. There are few related cases of lichen planus presenting as isotopic response. We report a case of a 74 year-old woman, with multiple itchy, rose-colored and shiny papules that developed at site of previously healed herpes zoster, on the right arm and shoulder. The pathogenesis of this phenomenon is still unknown and further studies are needed.
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Affiliation(s)
| | | | | | | | - Ney Romiti
- Centro Universitário Lusíada, Santos, SP, BR
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Schnebelen AM, Page J, Gardner JM, Shalin SC. Benign lymphangioendothelioma presenting as a giant flank mass. J Cutan Pathol 2014; 42:217-221. [PMID: 25410589 DOI: 10.1111/cup.12453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/24/2014] [Accepted: 05/12/2014] [Indexed: 11/27/2022]
Abstract
Benign lymphangioendothelioma is a rare lesion of controversial etiology and a histopathologic mimic of Kaposi sarcoma and so-called 'well-differentiated' angiosarcoma. Its most typical clinical presentation is as a slowly expanding, erythematous patch or plaque; it rarely presents as a large mass. We report the second case of a giant benign lymphangioendothelioma, which arose as a serpiginous mass involving most of the flank of an elderly male with no prior radiation exposure and with a remote history of herpes zoster infection. A biopsy revealed numerous anastomosing vascular channels extending from the superficial dermis to the subcutis that were dilated to progressively slit-like in architecture. The endothelial cells lacked cytologic atypia, hobnailing, or significant mitotic activity, and human herpesvirus-8 expression was absent. Positivity for podoplanin (D2-40) was observed in the endothelial cells, supporting a lymphatic phenotype. Furthermore, the lesional cells lacked immunohistochemical expression of Wilms tumor 1, providing further support of a malformative - rather than neoplastic - pathogenesis.
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Affiliation(s)
- Alicia M Schnebelen
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Page
- Arkansas Skin Cancer Center, Little Rock, AR, USA
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
BACKGROUND Wolf's isotopic response is the phenomenon of a new skin disease occurring at the site of another unrelated and already healed skin disorder. Most cases in the literature report herpes zoster (HZ) as the original disease; however, the isotopic responses vary greatly. Including this case, our literature search revealed 32 cases of isotopic granuloma annulare (GA) following HZ. CASE REPORT An 82-year-old male presented with GA localized to the right T9 dermatome that later appeared at other sites on the trunk and extremities. The patient had an episode of shingles involving the same dermatome 4 years earlier. DISCUSSION To our knowledge, this is the first case report of GA occurring initially as an isotopic response in an HZ scar and subsequently becoming generalized. Thirty-eight percent (12 of 32) of patients with isotopic GA following HZ were immunocompromised, which is similar to the published rate of immunodeficiency in patients with HZ.
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Katibi OS, Dlova NC, Mosam A. Cutaneous cytomegalovirus infection on multi dermatomal herpes zoster scars: an isotopic immune response. Clin Exp Dermatol 2014; 40:42-4. [PMID: 25266481 DOI: 10.1111/ced.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/28/2022]
Abstract
As more patients with human immunodeficiency virus (HIV) are surviving, despite severe immune suppression, clinicians are faced with atypical manifestations of both common and uncommon dermatoses. A 30-year-old black South African woman presented with a 10-month history of multiple chronic ulcers appearing on a multidermatomal herpes zoster (HZ) scar. The woman was infected with HIV, and her CD4 count was 45 cells/μL. Histology and PCR revealed cytomegalovirus (CMV) infection. This case highlights an unusual presentation of cutaneous CMV occurring as an isotopic immune response on a pre-existing multidermatomal HZ scar.
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Affiliation(s)
- O S Katibi
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Dermatology Unit, Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
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