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.