PMC9390486_01
HV lesions.(A-F), (A) Insect bite hypersensitivity, (B) Vesicles on the neck, (C) Bulla and healing erosions, (D) Papulopustules on the forehead, (E) Typical round punched out varioliform scarring after healing of HV lesions on the forehead before allo-HCT, (F) Typical round punched out varioliform scarring after healing of HV lesions on the forehead after allo-HCT.
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The patient was also highly hypersensitive to insect bites [Figure 1A]. After three months, serous-filled vesicles began to appear around the papular erythematous changes [Figures 1B, C]. The skin lesions occurred with periods of exacerbation and remission [Figure 1D]. According to the WHO classification fulfilled criteria were presence of general symptoms, hypersensitivity to insect bites [Figure 1A] and no signs of organ involvement (besides skin). Papular eruptions healed quickly with no tendency to deep scar [Figures 1E, F].
Pathology of HV biopsy specimens. (A-D). (A) EBV antigen (EBER) is present in almost every cell. (B) Dominant cytotoxic T lymphocytes (CD8+) in the infiltrate. (C) Lymphocytic infiltrate in the dermis (H&E). (D) Skin ulceration (H&E).
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The images of the histopathology results and their description are presented in Figure 2 [Figure 2].
PET test at staging and check-ups at various stages of the therapy (A-C). (A) PET test at the time of staging - lesions on the forehead involving the skin and subcutaneous tissue. (B) Primary lesions on the forehead subsided. A new leasion occured on the temple - february 2021. (C) Complete regression of lesions - june 2021.
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PET-CT scanning showed features of scalp involvement, with no changes in the lymph nodes, liver and spleen [Figure 3].
Therapy stages depending on EBV viremia.
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Based on individual reports, different therapeutic regimens were used in the treatment preparing for HCT, as shown in Figure 4.