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\begin{document}

\title{Giant Cell Lichenoid Dermatitis within Healed Varicella Zoster Site}



\author[1]{Yara Alghamdi}%
\author[2]{Bashaer  Almahdi}%
\author[3]{Sahar Alsifri}%
\author[2]{Hassan Huwait}%
\author[4]{Abdulhadi  Jfri}%
\affil[1]{King Saud bin Abdulaziz University for Health Sciences }%
\affil[2]{Princess Norah Oncology Center, King Abdullah International Medical Research Center}%
\affil[3]{King Abdulaziz University}%
\affil[4]{King Saud bin Abdulaziz University for Health Sciences}%


\vspace{-1em}



  
  \date{May 28, 2024}


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\selectlanguage{english}
\begin{abstract}
There are dermatoses that can emerge at the site of healed herpes
zoster. Giant Cell Lichenoid dermatitis (GCLD) is a variant of skin
graft-versus-host disease that can appear in patients post-transplant.
Herein, we present a case of GCLD manifested withib healed varicella
zoster site.%
\end{abstract}%



\sloppy


\textbf{Giant Cell Lichenoid Dermatitis within Healed Varicella Zoster
Site}

Yara Alghamdi\textsuperscript{1,2}, Bashaer Almahdi\textsuperscript{3},
Sahar Alsifri\textsuperscript{4}, Hassan Huwait\textsuperscript{5},
Abdulhadi Jfri\textsuperscript{2,3}

\begin{enumerate}
\tightlist
\item
  College of Medicine, King Saud bin Abdulaziz Univer for Health
  Sciences, Jeddah, Saudi Arabia
\item
  King Abdullah International Medical Research Center, Ministry of the
  National Guard - Health Affairs, Jeddah, Saudi Arabia.
\item
  Dermatology-Department of Medicine, Princess Norah Oncology Center,
  King Abdullah International Medical Research Center, Jeddah, Saudi
  Arabia
\item
  College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
\item
  Histo-pathology Department, Princess Norah Oncology Center, King
  Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
\end{enumerate}

\textbf{Conflict of interest:} None

\textbf{Financial support:} None

All authors have contributed significantly to the manuscript. Written
informed consent was obtained from the patient to publish this report in
accordance with the journal's patient consent policy.

\textbf{Word count:} 306

\textbf{Number of figures:} 3

\textbf{Number of references:} 2

\textbf{Corresponding author}

Abdulhadi Jfri, MD, MSc, FRCPC, FAAD. Assistant professor of
dermatology, College of Medicine, King Saud bin Abdulaziz University for
Health Sciences, Jeddah, Saudi Arabia, 22384, 2919.
Email:\emph{Jfria@ksau-hs.edu.sa} Fax: +966 12 6340653

\textbf{Key words:} Varicella zoster, herpes zoster, lichenoid
dermatitis, VZ, dermatology.

\textbf{Case Image}

A 33-year-old female with relapsed acute myelocytic leukemia (AML)
underwent allogeneic stem cell transplantation and developed
graft-versus-host disease (GVHD) affecting the liver and a history of
varicella zoster (VZ) infection involving C2, C3, and C4 dermatomes that
was managed with intravenous acyclovir. She presented with pruritic,
hyper-pigmented papules over the VZ-healed site (\textbf{Figure 1} ).
Wickham striae over the oral mucosa were observed. A 4-mm skin biopsy
showed lichenoid dermatitis with giant cells (\textbf{Figure 2} ). The
patient was managed with topical clobetasol (0.05\%) ointment twice
daily. At just one week's follow-up examination, the lichenoid eruption
had improved significantly.

\textbf{QUIZ QUESTION: What is your diagnosis?}

The diagnosis was giant cell lichenoid dermatitis within the healed VZ
site. Comedones, granulomas annulare, tuberculoid granulomas, sarcoidal
granulomas, acneiform eruptions, psoriasis, lichen plants, and lichenoid
graft-versus-host disease (GVHD) have all been reported at the site of
resolved HZ. {[}1{]} Cordoba et al. {[}2{]} reported the first case of
giant cell lichenoid dermatitis within HZ scars in post-BMT patients.
The diagnosis was based on the presence of numerous multinucleated giant
cells in the papillary dermis. The small papules resemble lichen planus
(LP), and although it has been described as a possible dermatological
eruption within the HZ site, histopathological evaluation supports the
presence of prominent multi-nucleated giant cells. The wolf-isotopic
response, the occurrence of a new dermatosis over an old and healed
dermatosis, could occur in patients with previous cutaneous
varicelliform eruptions. High clinical suspicion for cutaneous GVHD
should be considered, especially in patients post-bone marrow
transplant. Clinical correlation along with histopathological
confirmation should guide the diagnosis in such cases. The wolf-isotopic
response, occurrence of a new dermatosis over an old and healed
dermatosis, could occur in patients with previous cutaneous
varicelliform eruption. High clinical suspicion for cutaneous GVHD
should be considered; especially in patients post-bone marrow
transplant. Clinical correlation along with Histopathological
confirmation should guide diagnosis in such cases.

\textbf{References:}

Requena L, Kutzner H, Escalonilla P, Ortiz S, Schaller J, Rohwedder A.
Cutaneous reactions at sites of herpes zoster scars: an expanded
spectrum. Br J Dermatol. 1998 Jan;138(1):161-8. doi:
10.1046/j.1365-2133.1998.02045.x.

C\selectlanguage{ngerman}órdoba S, Fraga J, Bartolomé B, García-Díez A, Fernández-Herrera J.
Giant cell lichenoid dermatitis within herpes zoster scars in a bone
marrow recipient. J Cutan Pathol. 2000 May;27(5):255-7. doi:
10.1034/j.1600-0560.2000.027005255.x.

\textbf{Figures}

\textbf{Figure 1.} Lichenified Hyper-pigmented scaly plaques
distribution over C2, C3, C4 dermatomes and involving the sites
previously affected site by herpes zoster.

\textbf{Figure 2.A.} Histology showing lymphocytic lichenoid infiltrates
with giant cell and pigment incontinence (H\&E x100)

\textbf{Figure 2.B.} Histology of giant cell and pigment incontinence.
(H\&E x 400)\selectlanguage{english}
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