Abstract:

Pityriasis lichenoides is a self-resolving dermatosis with clinical appearances ranging from the acute ulceronecrotic papules of pityriasis lichenoides et varioliformis acuta (PLEVA) to the scaly papules of pityriasis lichenoides chronica. While its etiology is unknown, preceding infection may play a role. We report the case of a 40-year-old female with a recent history of COVID-19 infection, presenting with new-onset pruritic lesions appearing on the face, trunk, and extremities. Multiple serial biopsies were then obtained over the course of two months. Early biopsies demonstrated extensive epidermal spongiosis, vesiculation, reticular degeneration, and a heavy lymphocytic infiltrate with a number of CD30 (+) cells in the epidermis. One biopsy was even positive for a TCR gamma gene rearrangement. Later biopsies demonstrated a milder histologic picture with basal vacuolar interface dermatitis, scattered necrotic keratinocytes, and a perivascular lymphocytic infiltrate with occasional extravasated erythrocytes suggestive of PLEVA. While the histopathologic findings in this case were unusual, CD30 (+) lymphocytes have been encountered not only in lymphoproliferative disorders, such as lymphomatoid papulosis, but also in virally induced infectious etiologies. Additionally, some cases of virally induced PLEVA have also had positive TCR gene rearrangement studies. In this case, given the histopathologic findings and the patients clinical improvement with oral azithromycin and topical triamcinolone, the diagnosis of PLEVA was ultimately rendered. To our knowledge, this is the first case describing a possible association between COVID-19 and PLEVA and additionally highlights the importance of clinicopathologic correlation.

Financial Disclosure:
No current or relevant financial relationships exist.

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Elie Saliba, MD