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Vitamin C deficiency presenting as a leukocytoclastic vasculitis
P2008
P2010
Cutaneous lichenoid graft-versus-host disease mimicking lupus erythematosus Rebeca Goiriz, Department of Dermatology, La Princesa University Hospital, Madrid, Spain; Pablo F. Pen˜as, Department of Dermatology, La Princesa University Hospital, Madrid, Spain; Javier Fraga, Department of Pathology, La Princesa University Hospital, Madrid, Spain; Amaro Garcı´a-Diez, Department of Dermatology, La Princesa University Hospital, Madrid, Spain Introduction: Cutaneous lichenoid graft-versus-host disease (GVHD) is characterized by the appearance of an eruption morphologically and histopathologically similar to lichen planus. However, atypical clinical presentations have been reported. We present 3 cases of patients that developed an atypical presentation of lichenoid chronic GVHD with lesions on malar regions mimicking a lupus erythematosus.
Kikuchi’s disease: Case report and review Amber Atwater, MD, University of Wisconsin Hospitals and Clinics, Madison, WI, United States; William Aughenbaugh, MD, University of Wisconsin Hospitals and Clinics, Madison, WI, United States
Case 1: A 48-year-old female underwent an allogeneic bone marrow transplantation from an HLA-identical sibling. On day 200, after withdrawal of cyclosporine, she presented with erythemato-violaceous papules on both malar regions, consistent with lichenoid GVHD. Histologic examination showed basal layer hydropic degeneration and necrotic keratinocytes surrounded by lymphocytes. A blood analysis was performed, including a determination of antinuclear antibodies (ANA) titer, which was negative. Case 2: An 18-year-old female underwent an allogeneic peripheral blood transplantation from an HLA-identical unrelated donor. On day 36, she presented an acute GVHD with generalized lesions on the skin and hepatic involvement. Treatment with oral prednisone and cyclosporine was started, with improvement of the lesions in 1 month. But subsequently, she presented with a generalized eruption consistent with lichenoid GVHD with involvement of the face, where the lesions coalesced adopting a butterfly rash configuration. Case 3: A 26-year-old female underwent an allogeneic peripheral blood transplantation from an HLA-identical unrelated donor. After several episodes of oral and vaginal lichenoid GVHD attended in another hospital, she presented 3 years after the transplantation in our hospital with the appearance of violaceous papules on the face that coalesced forming a butterfly rash. The biopsy performed showed a vacuolar interface dermatitis consistent with the diagnosis of lichenoid chronic GVHD. The blood analysis showed a positive ANA titer of 1/160. Treatment with oral prednisone and oral tacrolimus was started with resolution of the lesions. A new blood analysis was performed with negativization of ANA. Discussion: Cutaneous lichenoid GVHD may have an atypical presentation. A butterfly distribution has been reported in the literature. We describe 3 cases of patients that presented with a butterfly distribution of the lesions mimicking lupus erythematosus.
Kikuchi’s disease, also known as histiocytic necrotizing lymphadenitis, is a systemic illness with classic findings of cervical lymphadenopathy and fever. It has been associated with a number of infectious etiologies, but no single source has been identified. Diverse, often nonspecific cutaneous findings have been described in up to forty percent of cases, including urticaria, morbilliform eruptions, erythema, papules, plaques, nodules, pustules, ulcers, leukocytoclastic vasculitis, erythema multiforme, polymorphous light eruption, and eyelid edema. Diagnosis is confirmed by lymph node biopsy. Description of the histopathology of skin lesions is limited to single case reports and one small case series. Our patient was a 24-year-old woman with fevers, lymphadenopathy, liver, and hematologic abnormalities, and a skin eruption involving the face, chest, neck, upper back, and extremities. Lymph node biopsy revealed histiocytic necrotizing lymphadenitis, which confirmed the diagnosis of Kikuchi’s disease. Skin biopsy was consistent with Kikuchi’s disease. We describe this case and review the clinical presentations and histopathology of Kikuchi’s disease. Commercial support: None identified.
Commercial support: None identified.
P2009 Vegetating iododerma: A case report ´ i, Brazil; Roge´rio Patricia Kurizky, MD, Universidade Federal Fluminense, Nitero Estrella, MD, PhD, Universidade Federal Fluminense, Nitero´i, Brazil; Joelma Maria ´ i, Brazil Oliveira, MD, Universidade Federal Fluminense, Nitero
P2011
Case report 1: A 76-year-old woman developed multiple painful, 0.5 cm to 15 cm, vegetating, bullous, and ulcerative lesions on the face, scalp, ears, and buttocks after a 15-day course of an expectorant that contained potassium iodide. Clinical and histopathologic findings were consistent with the diagnosis of iododerma. A thorough search for an underlying disease was negative. On cessation of potassium iodide, a rapid improvement was achieved. Discussion: Many sources of iodine are described in the pathogenesis of iododerma and in our case, the development of the lesions was apparently related to expectorant agent, frequent cause of earlier reported cases. The commonest manifestation is a papulonodular eruption, usually developing in the seborrheic regions like the face, neck and upper trunk. Vegetating lesions, as like presented by our patient, is relatively rare. Usually the disease is not life threatening, and skin lesions resolve in 4 to 6 weeks after the causative factor is eliminated, as observed in our patient.
Vitamin C deficiency presenting as a leukocytoclastic vasculitis Nektarios Lountzis, MD, Geisinger Medical Center, Danville, PA, United States; William Tyler, MD, Geisinger Medical Center, Danville, PA, United States; Michele Maroon, MD, Geisinger Medical Center, Danville, PA, United States Vitamin C deficiency, a disease rarely seen in developed countries, results from poor dietary intake of ascorbic acid and is characterized in adults by hemorrhagic diathesis, hair follicle abnormalities, and severe periodontal disease. We present a 54-year-old white male with painful lower extremity ecchymoses and petechiae, who was initially suspected of having a leukocytoclastic vasculitis. Further examination revealed evidence of corkscrew hairs of his abdomen and legs with perifollicular hemorrhage accentuated on his anterior proximal thighs. Severe generalized periodontitis was also noted. The patient’s dietary history revealed several months to years of poor nutrition with virtually no fruits or vegetables. Social history revealed a single man who lived alone with a smoking history of 1.5 packs per day for 30 years as well as alcohol abuse. Scurvy was subsequently suspected and supported by a biopsy of the left anterior proximal leg that revealed sparse perivascular lymphohistiocytic inflammation with some focal perifollicular erythrocyte extravasation. A negligible ascorbic acid level of\0.12 mg/dL helped confirm the diagnosis. The patient rapidly improved with vitamin C 500 mg twice a day. This case is presented to increase awareness and recognition of this uncommon nutritional deficiency in westernized society.
Commercial support: None identified.
Commercial support: None identified.
Background: Iododerma is a skin eruption that results of the exposure to iodinecontaining drugs or substances. Despite the frequent use and importance of iodides in medicine, nowadays, one rarely encounters this kind of disorders associated to their administration.
FEBRUARY 2007
J AM ACAD DERMATOL
AB135
P2010
Cutaneous lichenoid graft-versus-host disease mimicking lupus erythematosus Rebeca Goiriz, Department of Dermatology, La Princesa University Hospital, Madrid, Spain; Pablo F. Pen˜as, Department of Dermatology, La Princesa University Hospital, Madrid, Spain; Javier Fraga, Department of Pathology, La Princesa University Hospital, Madrid, Spain; Amaro Garcı´a-Diez, Department of Dermatology, La Princesa University Hospital, Madrid, Spain Introduction: Cutaneous lichenoid graft-versus-host disease (GVHD) is characterized by the appearance of an eruption morphologically and histopathologically similar to lichen planus. However, atypical clinical presentations have been reported. We present 3 cases of patients that developed an atypical presentation of lichenoid chronic GVHD with lesions on malar regions mimicking a lupus erythematosus.
Kikuchi’s disease: Case report and review Amber Atwater, MD, University of Wisconsin Hospitals and Clinics, Madison, WI, United States; William Aughenbaugh, MD, University of Wisconsin Hospitals and Clinics, Madison, WI, United States
Case 1: A 48-year-old female underwent an allogeneic bone marrow transplantation from an HLA-identical sibling. On day 200, after withdrawal of cyclosporine, she presented with erythemato-violaceous papules on both malar regions, consistent with lichenoid GVHD. Histologic examination showed basal layer hydropic degeneration and necrotic keratinocytes surrounded by lymphocytes. A blood analysis was performed, including a determination of antinuclear antibodies (ANA) titer, which was negative. Case 2: An 18-year-old female underwent an allogeneic peripheral blood transplantation from an HLA-identical unrelated donor. On day 36, she presented an acute GVHD with generalized lesions on the skin and hepatic involvement. Treatment with oral prednisone and cyclosporine was started, with improvement of the lesions in 1 month. But subsequently, she presented with a generalized eruption consistent with lichenoid GVHD with involvement of the face, where the lesions coalesced adopting a butterfly rash configuration. Case 3: A 26-year-old female underwent an allogeneic peripheral blood transplantation from an HLA-identical unrelated donor. After several episodes of oral and vaginal lichenoid GVHD attended in another hospital, she presented 3 years after the transplantation in our hospital with the appearance of violaceous papules on the face that coalesced forming a butterfly rash. The biopsy performed showed a vacuolar interface dermatitis consistent with the diagnosis of lichenoid chronic GVHD. The blood analysis showed a positive ANA titer of 1/160. Treatment with oral prednisone and oral tacrolimus was started with resolution of the lesions. A new blood analysis was performed with negativization of ANA. Discussion: Cutaneous lichenoid GVHD may have an atypical presentation. A butterfly distribution has been reported in the literature. We describe 3 cases of patients that presented with a butterfly distribution of the lesions mimicking lupus erythematosus.
Kikuchi’s disease, also known as histiocytic necrotizing lymphadenitis, is a systemic illness with classic findings of cervical lymphadenopathy and fever. It has been associated with a number of infectious etiologies, but no single source has been identified. Diverse, often nonspecific cutaneous findings have been described in up to forty percent of cases, including urticaria, morbilliform eruptions, erythema, papules, plaques, nodules, pustules, ulcers, leukocytoclastic vasculitis, erythema multiforme, polymorphous light eruption, and eyelid edema. Diagnosis is confirmed by lymph node biopsy. Description of the histopathology of skin lesions is limited to single case reports and one small case series. Our patient was a 24-year-old woman with fevers, lymphadenopathy, liver, and hematologic abnormalities, and a skin eruption involving the face, chest, neck, upper back, and extremities. Lymph node biopsy revealed histiocytic necrotizing lymphadenitis, which confirmed the diagnosis of Kikuchi’s disease. Skin biopsy was consistent with Kikuchi’s disease. We describe this case and review the clinical presentations and histopathology of Kikuchi’s disease. Commercial support: None identified.
Commercial support: None identified.
P2009 Vegetating iododerma: A case report ´ i, Brazil; Roge´rio Patricia Kurizky, MD, Universidade Federal Fluminense, Nitero Estrella, MD, PhD, Universidade Federal Fluminense, Nitero´i, Brazil; Joelma Maria ´ i, Brazil Oliveira, MD, Universidade Federal Fluminense, Nitero
P2011
Case report 1: A 76-year-old woman developed multiple painful, 0.5 cm to 15 cm, vegetating, bullous, and ulcerative lesions on the face, scalp, ears, and buttocks after a 15-day course of an expectorant that contained potassium iodide. Clinical and histopathologic findings were consistent with the diagnosis of iododerma. A thorough search for an underlying disease was negative. On cessation of potassium iodide, a rapid improvement was achieved. Discussion: Many sources of iodine are described in the pathogenesis of iododerma and in our case, the development of the lesions was apparently related to expectorant agent, frequent cause of earlier reported cases. The commonest manifestation is a papulonodular eruption, usually developing in the seborrheic regions like the face, neck and upper trunk. Vegetating lesions, as like presented by our patient, is relatively rare. Usually the disease is not life threatening, and skin lesions resolve in 4 to 6 weeks after the causative factor is eliminated, as observed in our patient.
Vitamin C deficiency presenting as a leukocytoclastic vasculitis Nektarios Lountzis, MD, Geisinger Medical Center, Danville, PA, United States; William Tyler, MD, Geisinger Medical Center, Danville, PA, United States; Michele Maroon, MD, Geisinger Medical Center, Danville, PA, United States Vitamin C deficiency, a disease rarely seen in developed countries, results from poor dietary intake of ascorbic acid and is characterized in adults by hemorrhagic diathesis, hair follicle abnormalities, and severe periodontal disease. We present a 54-year-old white male with painful lower extremity ecchymoses and petechiae, who was initially suspected of having a leukocytoclastic vasculitis. Further examination revealed evidence of corkscrew hairs of his abdomen and legs with perifollicular hemorrhage accentuated on his anterior proximal thighs. Severe generalized periodontitis was also noted. The patient’s dietary history revealed several months to years of poor nutrition with virtually no fruits or vegetables. Social history revealed a single man who lived alone with a smoking history of 1.5 packs per day for 30 years as well as alcohol abuse. Scurvy was subsequently suspected and supported by a biopsy of the left anterior proximal leg that revealed sparse perivascular lymphohistiocytic inflammation with some focal perifollicular erythrocyte extravasation. A negligible ascorbic acid level of\0.12 mg/dL helped confirm the diagnosis. The patient rapidly improved with vitamin C 500 mg twice a day. This case is presented to increase awareness and recognition of this uncommon nutritional deficiency in westernized society.
Commercial support: None identified.
Commercial support: None identified.
Background: Iododerma is a skin eruption that results of the exposure to iodinecontaining drugs or substances. Despite the frequent use and importance of iodides in medicine, nowadays, one rarely encounters this kind of disorders associated to their administration.
FEBRUARY 2007
J AM ACAD DERMATOL
AB135