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.