Abstract

A 24-year-old woman presented with a two-week history of a rash over the arms, legs, and trunk, demonstrating centrally necrotic erythematous papules and patches, as well as one week of fever and abdominal pain coinciding with onset of the rash. The history was remarkable only for a CT scan with intravenous radioiodide contrast dye several weeks prior. Histologic sections showed hyperkeratosis, focal parakeratosis, hypergranulosis, and focal spongiosis with areas of full-thickness epidermal necrosis and rare cytoid bodies. Within the superficial to mid dermis, there was a moderately dense perivascular, periadnexal, and interstitial lymphohistiocytic infiltrate with scattered neutrophils, occasional eosinophils, and extravasated erythrocytes, as well as areas of papillary dermal necrosis with karyorrhexis and fibrin deposition. Immunohistochemical stains were negative for HSV1, HSV2, and VZV. GMS and PAS special stains did not show fungal elements. The clinical and histopathologic features suggested a resolving pityriasis lichenoides et varioliformis acuta associated with recent intravenous contrast administration. This association has been described in rare case reports; we describe this case to draw further attention to this unusual reaction.