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Esfandiari N, Benson P, Morley K. Wolf's isotopic response: A case of dermatomal granuloma annulare after COVID-19 vaccination. JEADV CLINICAL PRACTICE 2022; 2:JVC290. [PMID: 38607911 PMCID: PMC9877862 DOI: 10.1002/jvc2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 04/14/2024]
Abstract
The SARS-CoV-2 pandemic was announced in March 2020, with the first vaccines becoming available later that year. Although generally well tolerated, there have been reports of skin reactions occurring after receiving COVID-19 vaccines, with a rare occurrence of granuloma annulare. Granuloma annulare can occur secondarily to herpes zoster infection in a phenomenon known as Wolf's isotopic response (WIR). WIR has been described to often occur after herpes zoster virus infection, at the location of the healed shingles rash, termed 'post-herpetic isotopic response' (PHIR). We present the first reported case of PHIR with granuloma annulare after the Moderna COVID-19 vaccination series. This reported reaction should not limit receipt of the COVID-19 vaccine, but awareness of this association can minimise additional work-up and treatment.
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Affiliation(s)
- Negar Esfandiari
- Division of DermatologyThe University of Vermont Medical CenterBurlingtonVermontUSA
| | - Patrick Benson
- Department of Dermatology, InterMed, P.ASouth PortlandMaineUSA
| | - Keith Morley
- Division of DermatologyThe University of Vermont Medical CenterBurlingtonVermontUSA
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2
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Tabb ES, Duncan LM, Nazarian RM. Eosinophilic granulomatosis with polyangiitis: Cutaneous clinical and histopathologic differential diagnosis. J Cutan Pathol 2021; 48:1379-1386. [PMID: 34019312 DOI: 10.1111/cup.14065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, but severe systemic vasculitis that can affect skin and other organ systems. Diagnostic criteria have evolved, and many attempts have been made to classify the vasculitides based on clinical and/or histopathologic features, with an aim to develop standardized criteria. According to the EGPA Consensus Task Force recommendations, EGPA is a syndrome of asthma, eosinophilia, pulmonary infiltrates, and extrapulmonary vasculitis (such as cutaneous involvement with purpura). Histopathologic evidence of vasculitis in EGPA may be associated with eosinophilic infiltration and/or perivascular granulomatous inflammation. We review clinicopathologic criteria of this enigmatic vasculopathy.
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Affiliation(s)
- Elisabeth S Tabb
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalynn M Nazarian
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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3
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Valenzuela-Ubiña S, Jiménez-Gallo D, Villegas-Romero I, Navarro-Navarro I, Linares-Barrios M. Psoriasis over healed inflammatory linear verrucous epidermal nevus: Wolf´s isotopic response. Australas J Dermatol 2021; 62:435-436. [PMID: 33634850 DOI: 10.1111/ajd.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra Valenzuela-Ubiña
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - David Jiménez-Gallo
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Isabel Villegas-Romero
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Irene Navarro-Navarro
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mario Linares-Barrios
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain
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4
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Singh P, Wolfe SP, Alloo A, Gottesman SP. Interstitial granulomatous dermatitis and granulomatous arteritis in the setting of PD-1 inhibitor therapy for metastatic melanoma. J Cutan Pathol 2020; 47:65-69. [PMID: 31390071 DOI: 10.1111/cup.13562] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 07/13/2019] [Accepted: 08/01/2019] [Indexed: 12/29/2022]
Abstract
Checkpoint inhibition has become an important target in the management of malignant melanoma. As anti-CTLA4 inhibitors and anti-PD1 antibodies are increasingly utilized, reports of immune-related adverse events (IRAEs) are becoming more frequent. Common noted cutaneous IRAEs are morbilliform, lichenoid, bullous, granulomatous, psoriasiform, and eczematous eruptions. We report a case of interstitial granulomatous dermatitis and granulomatous arteritis in the setting of nivolumab (anti-PD1) monotherapy for metastatic melanoma. There are many different causes for granulomatous vasculitis, such as herpes virus infection, lymphoproliferative disorders, systemic vasculitis, and inflammatory bowel disease. This report adds to the growing literature on granulomatous IRAEs due to checkpoint inhibition.
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Affiliation(s)
- Parmvir Singh
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Scott P Wolfe
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Allireza Alloo
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Silvija P Gottesman
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Kohn D, Lupatsch F, Wetzig T. [Persistent skin lesions after acute zoster infection]. Hautarzt 2019; 70:228-230. [PMID: 30656383 DOI: 10.1007/s00105-018-4352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D Kohn
- Klinik für Dermatologie, Dermatochirurgie und Allergologie, Asklepios Klinik Weißenfels, Naumburger Str. 76, 06667, Weißenfels, Deutschland.
| | - F Lupatsch
- Klinik für Dermatologie, Dermatochirurgie und Allergologie, Asklepios Klinik Weißenfels, Naumburger Str. 76, 06667, Weißenfels, Deutschland
| | - T Wetzig
- Klinik für Dermatologie, Dermatochirurgie und Allergologie, Asklepios Klinik Weißenfels, Naumburger Str. 76, 06667, Weißenfels, Deutschland
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6
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McCoy WH, Otchere E, Musiek AC, Anadkat MJ. Granulomatous dermatitis as a postherpetic isotopic response in immunocompromised patients: A report of 5 cases. JAAD Case Rep 2018; 4:752-760. [PMID: 30246119 PMCID: PMC6141645 DOI: 10.1016/j.jdcr.2018.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Key Words
- AML, acute myelogenous leukemia
- CLL, chronic lymphocytic leukemia
- Chronic lymphocytic leukemia
- GA, granuloma annulare
- GD, granulomatous dermatitis
- HSV, herpes simplex virus
- MM, multiple myeloma
- PHIR, postherpetic isotopic response
- PHIR-GD, postherpetic isotopic response-granulomatous dermatitis
- PHN, postherpetic neuralgia
- SCT, stem cell transplant
- SLE, systemic lupus erythematous
- SS, Sjogren syndrome
- VZV, varicella zoster virus
- Wolf's isotopic response
- granuloma annulare
- granulomatous dermatitis
- immunocompromise
- immunocompromised district
- immunodeficiency
- immunosuppression
- isotopic response
- locus minoris resistentiae
- postherpetic isotopic response
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Affiliation(s)
- William H. McCoy
- Department of Medicine, Saint Louis, Missouri
- Division of Dermatology, Saint Louis, Missouri
- Washington University School of Medicine, Saint Louis, Missouri
- Correspondence to: William H. McCoy 4th, MD, PhD, Department of Medicine, Division of Dermatology, Washington University, 660 S Euclid, Campus Box 8123, St. Louis, MO 63110.
| | - Elaine Otchere
- Washington University School of Medicine, Saint Louis, Missouri
| | - Amy C. Musiek
- Department of Medicine, Saint Louis, Missouri
- Division of Dermatology, Saint Louis, Missouri
- Washington University School of Medicine, Saint Louis, Missouri
| | - Milan J. Anadkat
- Department of Medicine, Saint Louis, Missouri
- Division of Dermatology, Saint Louis, Missouri
- Washington University School of Medicine, Saint Louis, Missouri
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7
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Terziroli Beretta-Piccoli B, Mainetti C, Peeters MA, Laffitte E. Cutaneous Granulomatosis: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 54:131-146. [PMID: 29352388 DOI: 10.1007/s12016-017-8666-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cutaneous granulomatosis is a heterogeneous group of diseases, characterized by a skin inflammatory reaction triggered by a wide variety of stimuli, including infections, foreign bodies, malignancy, metabolites, and chemicals. From a pathogenic point of view, they are divided into non-infectious and infectious granulomas. Pathophysiological mechanisms are still poorly understood. Non-infectious granulomatous skin diseases include granuloma annulare, necrobiosis lipoidica, rheumatic nodules, foreign body granulomas, cutaneous sarcoidosis, and interstitial granulomatous dermatitis. Necrobiosis lipoidica is more frequent in diabetic patients. Infectious granulomas of the skin are caused by mycobacteria, in particular Mycobacterium tuberculosis or atypical mycobacteria; parasites, such as Leishmania; or fungi. Pathogenic mechanisms of M. tuberculosis-related granuloma are discussed. From a clinical point of view, it is useful to divide cutaneous granulomatosis into localized and more disseminated forms, although this distinction can be sometimes artificial. Three types of localized granulomatous lesions can be distinguished: palisaded granulomas (granuloma annulare, necrobiosis lipoidica, and rheumatoid nodules), foreign body granulomas, and infectious granulomas, which are generally associated with localized infections. Disseminated cutaneous granulomas can be divided into infectious, in particular tuberculosis, and non-infectious forms, among which sarcoidosis and interstitial granulomatous dermatitis. From a histological point of view, the common denominator is the presence of a granulomatous inflammatory infiltrate in the dermis and/or hypodermis; this infiltrate is mainly composed of macrophages grouped into nodules having a nodular, palisaded or interstitial architecture. Finally, we propose which diagnostic procedure should be performed when facing a patient with a suspected cutaneous granulomatosis.
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Affiliation(s)
| | - Carlo Mainetti
- Department of Dermatology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | | | - Emmanuel Laffitte
- Clinique de Dermatologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
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Mashayekhi Gyonlo V, Kiafar B, Taheri Bojd AR, Sabouri Rad S. Consecutive occurrence of isotopic and isomorphic response in a patient: Patchy granuloma annulare arising in the site of herpes zoster scar and seborrhoeic dermatitis. Australas J Dermatol 2017; 58:e155-e156. [PMID: 28670742 DOI: 10.1111/ajd.12533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vahid Mashayekhi Gyonlo
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Kiafar
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Reza Taheri Bojd
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Sabouri Rad
- Cutaneous Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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9
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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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10
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Storer M, Nazarian RM, Kourosh AS. Nonphoto-exposed initial cutaneous manifestation of lupus after zoster: A case of Wolf's isotopic reaction. JAAD Case Rep 2016; 2:425-427. [PMID: 27942574 PMCID: PMC5133640 DOI: 10.1016/j.jdcr.2016.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Molly Storer
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rosalynn M Nazarian
- Pathology Service, Dermatopathology Unit, Massachusetts General Hospital, Boston, Massachusetts
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11
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Piette EW, Rosenbach M. Granuloma annulare. J Am Acad Dermatol 2016; 75:467-479. [DOI: 10.1016/j.jaad.2015.03.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/10/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022]
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12
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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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Ferenczi K, Rosenberg AS, McCalmont TH, Kwon EJ, Elenitsas R, Somach SC. Herpes zoster granulomatous dermatitis: histopathologic findings in a case series. J Cutan Pathol 2015; 42:739-45. [PMID: 25970643 DOI: 10.1111/cup.12531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 11/28/2022]
Abstract
Several types of cutaneous reactions have been reported to arise at the site of herpes zoster (HZ) infection weeks to years after the acute disease. Among these, granulomatous reactions are the most frequently reported. In this study, we describe the spectrum of histopathologic findings of HZ granulomatous reactions observed in 26 patients with cutaneous lesions confined to the area of previous HZ eruption and compare them with biopsy specimens taken from 25 patients with acute HZ. All patients with persistent reactions from whom history was available presented within 12 weeks of the onset of the acute eruption. The most frequent findings were interstitial granulomatous dermatitis with lymphocytes, histiocytes and multinucleated giant cells displaying elastophagocytosis and a perineural, perivascular and perieccrine mononuclear inflammatory infiltrate rich in lymphocytes and plasma cells. Less common features included intra-arrector and peri-arrector pili granulomas, follicular dilatation and hyperkeratosis, and vasculitis. Specimens from patients with acute HZ were found to have small numbers of perineural plasma cells and most had subtle granulomatous inflammation, in patterns similar to the group with late granulomatous reactions. Our findings suggest that granulomatous reactions to varicella zoster virus represent a persistent evolving inflammatory reaction after acute infection.
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Affiliation(s)
- Katalin Ferenczi
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Arlene S Rosenberg
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Timothy H McCalmont
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Eun Ji Kwon
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen C Somach
- Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Lo Schiavo A, Ruocco E, Gambardella A, O'Leary RE, Gee S. Granulomatous dysimmune reactions (sarcoidosis, granuloma annulare, and others) on differently injured skin areas. Clin Dermatol 2015; 32:646-53. [PMID: 25160106 DOI: 10.1016/j.clindermatol.2014.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Granulomatous disorders are chronic cell-mediated immune responses histologically characterized by collections of macrophages, epithelioid cells, and multinucleated giant cells. This disease spectrum often has an infectious origin, but sometimes neither an infective agent nor an inciting antigenic stimulus can be identified. The skin may be a preferential target for these disorders, especially in the areas that have been damaged by various forms of skin injury (eg, herpetic infections, trauma, thermal or solar burns, vaccinations, tattoos). These damaged skin sites frame the new concept of an immunocompromised cutaneous district (ICD), which defines a skin area with acquired immune dysregulation that can pave the way for the local onset of opportunistic disorders, such as infections, tumors, and granulomatous disorders. Sarcoidosis, granuloma annulare (GA), and forms of granulomatous vasculitis, such as Churg-Strauss syndrome (CSS) and Wegener's granulomatosis (WG), are the most common granulomatous disorders that occur in an ICD and may share common pathogenic mechanisms. Recent studies have found clinical and pathologic overlapping features across noninfectious granulomas. Although no unifying etiology exists, the development of granulomatous processes in the ICD has often been reported and the literature contains various hypotheses to explain it: (1) overactive immune response in a previously injured region with or without loss of immune tolerance; (2) overall reduced immune response; (3) retention of an exogeneous antigen or foreign body; (4) altered neural signaling; and (5) a combination of all the aforementioned processes. T helper cells, T regulatory cells, and macrophages, as well as a number of antigenic proteins, have been identified as potential contributing factors. In addition, a genetic predisposition and an intact systemic immune system are both instrumental for the persistence of local granuloma formation in the ICD.
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Alessio Gambardella
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ryan E O'Leary
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah Gee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Wolf's post-herpetic isotopic response: Infections, tumors, and immune disorders arising on the site of healed herpetic infection. Clin Dermatol 2015; 32:561-8. [PMID: 25160097 DOI: 10.1016/j.clindermatol.2014.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Herpes simplex viruses (HSV-1/HSV-2) and varicella-zoster virus (VZV) have several characteristics in common. Both are epidermoneurotropic, cause skin eruptions accompanied by sensory symptoms (itch, pain), damage peripheral sensory nerve fibers and cutaneous nerve endings, and interfere with neuromediator release, which can alter local mechanisms of immune control. For this reason, herpes-infected areas may become a preferential location for the subsequent onset of immunity-related skin disorders (infections, tumors, and dysimmune reactions), an event first reported by a neurologist and focused on by two brothers, a dermatologist and a pediatrician. The phenomenon therefore named Wolf's post-herpetic isotopic response (PHIR) refers to the occurrence of a new skin disorder at the site of a previous and already healed herpetic eruption (herpes zoster in most cases). Until now, we have been able to gather 189 well-documented cases of PHIR (all reported in the reference section), but our list is far from being complete. Some of the most emblematic cases are briefly described here. In some circumstances, the opposite of PHIR occurs, with diffuse skin disorders or eruptions that selectively spare herpes-infected areas (Wolf's post-herpetic isotopic nonresponse). Experimental investigations with patch testing have been performed in seven patients who were sensitized to nickel and had had herpes zoster in the past years. The tests were carried out bilaterally on the affected dermatomes and on the unaffected contralateral ones. The uneven immune responses we obtained have shown that the immune behavior of an herpes zoster-affected dermatome can be different from that of the corresponding contralateral dermatome, thus supporting the existence of immune dysregulation in herpes-infected areas.
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16
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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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18
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Mahony J, Helms SE, Brodell RT. The sarcoidal granuloma: A unifying hypothesis for an enigmatic response. Clin Dermatol 2014; 32:654-9. [DOI: 10.1016/j.clindermatol.2014.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Generalized granuloma annulare after varicella infection: Wolf isotopic response? J Am Acad Dermatol 2014; 71:e80-2. [PMID: 25128135 DOI: 10.1016/j.jaad.2014.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 11/21/2022]
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