T‐cell pseudolymphoma in recurrent herpes simplex virus infection

Abstract

Background: In cases of herpes virus infection without typical histologic (and clinical) signs it is difficult to achieve the correct diagnosis by histology alone. Some of those cases are prone to be misdiagnosed as cutaneous lymphoma.Methods: This retrospective study included five patients with herpes simplex virus (HSV)-associated pseudolymphoma. We investigated clinical, histomorphologic and immunophenotypic features of all patients.Results: All biopsy specimens presented a superficial and deep perivascular lymphohistiocytic infiltrate with epidermotropism, atypia and admixed plasma cells to varying degrees. Four of five samples showed lining-up of lymphocytes in the junctional zone with predominance of CD8+ lymphocytes, in contrast to the dermal part (inverse CD8:CD4 ratio). Papillary edema was found in four of five cases. Clinically, patchy erythema located on the buttocks and adjacent areas was typical, sometimes with erosions and crusts. Medical history of recurrent blisters, pain or itching was additionally helpful.Conclusion: We point out subtle but consistent histomorphologic criteria, which were helpful to diagnose HSV-associated pseudolymphoma in context with the clinical presentation. K E Y W O R D Sbuttocks, herpes simplex, inverse CD8:CD4 ratio, pseudolymphoma, T-cell lymphoma

Cutaneous pseudolymphoma—A review on the spectrum and a proposal for a new classification

“…Plasma cells were found in all cases, but to a highly variable degree . As already reported as a clue for herpes incognito, papillary edema is a common finding . The lymphocytes were slightly enlarged, with atypical, chromatin‐dense nuclei, and presented a lining‐up in four of the five investigated cases; the intraepidermal lymphocytes were predominantly CD8+ .…”

“…The hair follicles were usually affected, with inflammation in the sebaceous glands, in and around the arrectores pilorum muscles and around the eccrine/apocrine ducts . Plasma cells were found in all cases, but to a highly variable degree . As already reported as a clue for herpes incognito, papillary edema is a common finding .…”

“…HSV infections demonstrated a pandermal perivascular and periadnexal T‐cell‐rich infiltrate with a variable number of admixed histiocytes. The hair follicles were usually affected, with inflammation in the sebaceous glands, in and around the arrectores pilorum muscles and around the eccrine/apocrine ducts . Plasma cells were found in all cases, but to a highly variable degree .…”

“…In infections with varicella zoster virus (VZV) and herpes simplex virus (HSV) , lymphocyte‐rich infiltrates without typical epithelial herpesvirus alterations can occur. Some of these cases were described as herpes incognito, others as simulators of cutaneous T‐cell lymphomas . HSV infections demonstrated a pandermal perivascular and periadnexal T‐cell‐rich infiltrate with a variable number of admixed histiocytes.…”

“…Others persist over months or even years. A re‐exposure to the particular cause may incite a recurrence . Progression or a so‐called “aggressive course” of PSL has been rarely reported .…”