PMC10368974_01
Clinical presentation of our patient at first medical contact. The patient presented with a diffuse cutaneous eruption of violaceous, polygonal, slightly scaling papules on her trunk and limbs (A, B) with a marked tendency to coalesce into plaques, especially on the dorsal surface of both her hands and feet (C).
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On clinical examination she presented with widespread erythematous papular lesions with violaceous hue disseminated to her trunk and limbs, some of which showed a peculiar polygonal shape and a marked tendency to coalesce into plaques, especially on the dorsal surface of her hands and feet ( Figures 1A-C ).
Histopathological and immunopathological findings. (A, B) Histopathological examination of a skin lesion on the dorsal surface of the hand showed irregular epidermal hyperplasia with hyperothokeratosis and vacuolar degeneration of basal keratinocytes, while a band-like lymphohistiocytic infiltrate could be found in the upper dermis. Direct immunofluorescence showed linear C3 (C) and IgG (D) deposits along the dermo-epidermal junction. (E) Indirect immunofluorescence on salt-split skin showed IgG linear deposits on the epidermal side of the dermo-epidermal junction. (F) Indirect immunofluorescence on Dermatology Mosaic 7 Biochip showed positivity for Ag BP180.
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Based on clinical evaluation and histopathologic evidence of lichenoid tissue reaction ( Figures 2A, B ) a diagnosis of Lichen planus (LP) was made and the patient was started with 25 mg/day of prednisone with a gradual slow tapering every 10 days. Direct immunofluorescence (DIF) on perilesional skin showed IgG and C3 linear deposits at the dermo-epidermal junction and indirect immunofluorescence (IIF) revealed IgG linear deposits on the epidermal side of the dermo-epidermal junction with presence of autoantibodies against the BP180 antigen ( Figures 2C-F ).
Clinical evolution of our patient. (A, B) Clinical pictures immediately following Sars-CoV2 infection when the patients developed tense serous bullae on previously unaffected skin (see arrows). (C, D) Clinical pictures of the same areas at 1-week follow-up when only hyperpigmented post-inflammatory marks could be observed.
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Concomitant to the onset of the respiratory infection she started developing tense, serous bullae on the inner surface of her right thigh as well as on the volar side of her right forearm, outside the pre-existing lichenoid lesions ( Figures 3A, B ). This was confirmed at the following medical contact the next week when most of her skin was surprisingly cleared of bullae and papulae and only diffuse hyperpigmented post-inflammatory marks could be found ( Figures 3C, D ).