Track: Case Reports

Abstract:

Cutaneous Lupus Erythematosus (CLE) and Lichen Planus (LP) are autoinflammatory dermatoses with disparate yet varied clinical presentations, that exhibit classically distinct histopathologic and direct immunofluorescence (DIF) patterns. A relatively uncommon overlap syndrome of CLE and LP has been described, having overlapping clinical and/or histopathological features of these entities, however, the DIF patterns of this overlap syndrome have not been extensively characterized to date. Herein, we report two cases of CLE/LP overlap syndrome, with additional diagnostic support provided by DIF analysis. (1) A 67-year-old Caucasian woman with a working diagnosis of cutaneous lupus, presented with a flare marked by unusual evolution of her clinical morphology involving the face, upper chest/back, and shoulders. Biopsy revealed an atrophic vacuolar interface dermatitis similar to her prior specimens, with DIF analysis demonstrating junctional fibrinogen deposition, without additional immunoreactant positivity. (2) A 68-year-old Black American woman with a history of dyshidrotic eczema presented with eruptive violaceous papules and plaques localized to the legs, scalp, vulvar, and inframammary areas. Biopsy of these lesions demonstrated lichenoid dermatitis, with the scalp specimen additionally demonstrating a deep perivascular and periadnexal infiltrate consistent with cutaneous lupus, and the leg specimen displaying perivascular lymphocytes and erythrocytes consistent with lichenoid pigmented purpuric dermatosis. DIF of the scalp was positive for junctional and periadnexal deposition of fibrinogen only, while the leg DIF showed perivascular fibrinogen and C3 deposition. The present series adds histopathologic insight to the limited CLE/LP overlap literature and highlights the diagnostic value of DIF analysis in lichenoid and autoimmune connective tissue dermatoses.

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Pearl Omo-sowho