Pruritic rash involving upper torso and extremities

Presenter: Scott Deckelbaum, DO
Dermatology Program: Western University/Pacific Hospital
Program Director: David Horowitz, DO
Submitted on: Feb 5, 2010

CHIEF COMPLAINT:  24 year old Hispanic male with complaint of a pruritic rash involving his upper torso and extremities. His symptoms have been slowly progressing over a 5 year period.

CLINICAL HISTORY:

Signs and symptoms:  Our patient reported diffuse pruritus without pain. His complete review of systems was otherwise negative including the presence of palpable masses.

Previous Treatment:  None.

Other information:  Past Medical, Family and Social History was non contributory. He immigrated from Mexico around 10 years prior and has no significant employment history.

PHYSICAL EXAM:

Large pink plaques with a fine overlying scale interspersed with violaceous pigmentation distributed in a reticular pattern with some notable telangiectasia and atrophy.

 

 

 

LABORATORY TESTS:

None. Our patient lacked insurance and was unable to comply with request for blood work or radiography.

DERMATOHISTOPATHOLOGY:

Subacute spongiotic dermatitis with scattered foci of spongiosis accompanied with mildly to moderately atypical lymphocytes. In multiple foci there are histopathologic changes suggestive of Pautrier microabscesses. There is a perivascular and interstitial lichenoid inflammatory cell infiltrate. Immunohistochemical findings showed strong CD4 positivity and focal loss of CD7 positivity.

 

 

 

 

DIFFERENTIAL DIAGNOSIS:

1.   Mycosis Fungoides – Poikiloderma Atrophicans Vasculare Variant
2.   Parapsoriasis En Plaque – Large Plaque Variety
3.   Lichen Sclerosis et trophicus
4.   Sceromyxedema
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