Abstract

Interface dermatitides include diseases in which the primary pathology involves the dermo-epidermal junction. The salient histological findings include basal cell vacuolization, apoptotic keratinocytes, and obscuring of the dermo-epidermal junction by inflammatory cells. Lupus erythematosus, dermatomyositis, lichen planus, graft-versus-host disease, erythema multiforme, fixed drug eruptions, lichen striatus, and pityriasis lichenoides are considered major interface diseases. Less common etiologies include infective, and neoplastic. We report a case of interface/lichenoid dermatitis secondary to Epstein-Barr Virus. A 15-year-old child who had high EBV titers and a six-month history of rash onset that started on scalp; spread to the abdomen and then the legs. The biopsy revealed hyperkeratosis, and acanthotic epidermis with prominent granular cell layer and basal cell vacuolization. There was perivascular to lichenoid mixed inflammation comprising predominantly of lymphocytes with fewer eosinophils. Prominent interface change with associated necrotic keratinocytes resulting blisters was observed throughout the epidermis. This histologic pattern of interface/lichenoid dermatitis associated with EBV is not widely known, rare reports of lichenoid pattern of infiltration are described associated with EBV and those reports are particularly described in context of Gianotti-Crosti syndrome. This case is presented to illustrate the fact that EBV associated rash can present as lichenoid dermatitis and should be added to the differential diagnoses of lichenoid infiltrates. When encountering interface/lichenoid dermatitis it might prove useful to include EBV serology among the tests.

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