A 43-year-old man with a history of recurrent herpes simplex, and without a
history of atopy, presented with a sudden appearance of an exanthem 10 day
s before presenting to the clinic. The exanthem affected the face, flexural
areas, hands, and feet. No local symptomatology and no systemic involvemen
t were observed.
The exploration revealed a polymorphous exanthem formed by maculopapular le
sions, umbilicated vesicles, crusts, and purpuric and necrotic elements, wi
th a pattern of acute pityriasis lichenoides (Figs 1 and 2).
The histopathologic examination of a skin biopsy specimen showed a dense ly
mphohistiocytic infiltrate, with a linear disposition over the entire thick
ness of the papillary dermis and in the upper part of the reticular dermis.
At the dermoepidermal junction, vacuolar alteration of the basal layer was
observed, with the presence of mononuclear exocytosis, edema extending to
the papillary dermis, and extravasated red cells. Spongiosis, keratinocytic
focal necrosis, and parakeratosis were observed in the epidermis (Fig. 3).
Analytical explorations revealed lymphocytosis and slight elevation of tran
saminases. Serologies to hepatitis A virus, hepatitis B virus, hepatitis C
virus, cytomegalovirus, human immunodeficiency virus (HIV) 1 and 2, syphili
s, and human parvovirus B19 were negative. The CD4 and CD8 lymphocyte count
s were normal. The serology to Epstein-Barr virus (EBV) (Table 1) was consi
stent with a primary infection by EBV. Oral acyclovir treatment, 1 g daily
for 7 days, was started and the exanthem disappeared in 7 days.