Pityriasis lichenoides‐like exanthem and primary infection by Epstein–Barr virus

Abstract

A 43‐year‐old man with a history of recurrent herpes simplex, and without a history of atopy, presented with a sudden appearance of an exanthem 10 days before presenting to the clinic. The exanthem affected the face, flexural areas, hands, and feet. No local symptomatology and no systemic involvement were observed. The exploration revealed a polymorphous exanthem formed by maculopapular lesions, umbilicated vesicles, crusts, and purpuric and necrotic elements, with a pattern of acute pityriasis lichenoides ( Figs 1 and 2). 1 Papular and necrotic lesions localized on the flexion surface of the arm 2 Papular and purpuric elements on the dorsum of the hand The histopathologic examination of a skin biopsy specimen showed a dense lymphohistiocytic infiltrate, with a linear disposition over the entire thickness of the papillary dermis and in the upper part of the reticular dermis. At the dermoepidermal junction, vacuolar alteration of the basal layer was observed, with the presence of mononuclear exocytosis, edema extending to the papillary dermis, and extravasated red cells. Spongiosis, keratinocytic focal necrosis, and parakeratosis were observed in the epidermis ( Fig. 3). 3 Spongiosis, keratinocytic focal necrosis, and parakeratosis are observed in the epidermis. The dermoepidermal junction shows vacuolar alteration of the basal layer and mononuclear exocytosis. In the papillary dermis, a dense lymphohistiocytic infiltrate is present with edema and extravasated red cells Analytical explorations revealed lymphocytosis and slight elevation of transaminases. Serologies to hepatitis A virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, human immunodeficiency virus (HIV) 1 and 2, syphilis, and human parvovirus B19 were negative. The CD4 and CD8 lymphocyte counts were normal. The serology to Epstein–Barr virus (EBV) ( Table 1) was consistent with a primary infection by EBV. Oral acyclovir treatment, 1 g daily for 7 days, was started and the exanthem disappeared in 7 days. Serologic evolution of EBV infection in our patient January 1998 February 1998 April 1998 IgM VCA++–IgG VCA+ (2,63)+ (1,97)+ (2,01)EBNA––+ EBNA, Epstein–Barr nuclear antigen; IgG, immunoglobulin G; IgM, immunoglobulin M; VCA, viral capside antigen.

Pityriasis lichenoides and its subtypes

“…The rash disappeared within 7 days of the initiation of oral acyclovir treatment. 73 In 2003 Klein et al 74 reported a 23-yearold woman who presented with a 3-day history of fever, sore throat, jaundice, dark urine, and claycolored stools, as well as a cutaneous eruption clinically and histopathologically consistent with PLC. Results of laboratory studies indicated acute infectious mononucleosis, and as her serologic results for EBV, results of hepatic function tests, and constitutional symptoms improved, her cutaneous lesions resolved.…”

Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha‐Habermann's disease

“…Evidence of serology, histopathology and treatment outcomes further suggested that the abnormal skin response of pityriais lichenoides could be a result of hypersensitivity reaction following the infection 2,3 . Among these, Toxoplasma gondii, 4 Epstein‐Barr virus, 5,6 parvovirus B19, M. pneumoniae, human immuno‐deficiency virus (HIV) 7 and group A β‐hemolytic streptococcus 8 have been indicated.…”

Dermatological manifestations of Epstein‐Barr virus systemic infection: a case report and literature review

“…It is possible, however, that the exanthem occurring during EBV acute IM shows atypical features with a scarlatiniform, vesicular, or petechial pattern 3,4,10,11,21 . Indeed, our patient showed an atypically widespread erythematous‐papulovesicular eruption during the acute phase of IM, which is a very rare occurrence (Table 1).…”

“…We found 264 studies related to the possible cutaneous and mucosal manifestations during EBV acute infection; we selected the articles that more exhaustively reported the clinical and laboratory description of the case/cases, 5‐45 published from 1954 to 2018 (Table 1).…”