Cutaneous leukemic infiltration following varicella - a case of Wolf's isotopic response

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.

Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

“…already included some cases of healed herpes simplex, varicella or phlebitis. Subsequently, the designation ‘isotopic response’ was used to describe many other triggering factors such as healed cutaneous leishmaniasis or tinea or erythema multiforme . According to Camargo et al ., ‘ the differences between Koebner phenomenon and Wolf phenomenon are unclear’.…”

Granuloma annulare-like eruption in chronic lymphocytic leukemia

“…Conversely, it is possible that neoplastic cells may be secondarily recruited to a site of primary dermatosis as a reactive inflammatory process [15]. For example, cutaneous B-CLL has been reported in healing varicella-zoster lesions [15,24,25]. In those cases, it is possible that Wolf isotopic response may have played a role, in which a specific cutaneous site that has been "immunocompromised" by a prior primary dermatosis may be subsequently affected by a secondary opportunistic pathology [25,26].…”

First case of primary diffuse large B‐cell lymphoma of skin as Wolf's postherpetic isotopic response

“…3,4 Lymphoid malignancies as Wolf's isotopic response are very rare (Table 1). [5][6][7][8][9][10] Another differential diagnosis needs consideration. In the We describe the first case of DLBCL as Wolf's isotopic response.…”