Wolf isotopic response manifesting as postherpetic granuloma annulare: a case series.
BACKGROUND
Wolf isotopic response has infrequently been reported in the literature, mainly as isolated case reports.


OBJECTIVE
To aid in recognition of the occurrence of postherpetic granuloma annulare for accurate histologic interpretation of granulomatous dermatitides.


METHODS
We report 5 cases of patients with Wolf isotopic response manifesting as granuloma annulare, developing in a site of previous herpes zoster, and discuss the clinicopathologic findings.


RESULTS
Previous infection with herpes zoster or herpes simplex virus was found in 5 of 5 cases reported. The differential diagnosis of a dermal lymphohistiocytic infiltrate with multinucleated giant cells includes postherpetic granuloma annulare.


CONCLUSIONS
All cases of postherpetic Wolf isotopic response reported in this series revealed granuloma annulare, with a perineurovascular or perifollicular pattern of lymphohistiocytic infiltration including multinucleated giant cells, and occurred following herpes zoster or herpes simplex infection, although herpes viral infection was not always associated with a subsequent isotopic eruption. Awareness of this entity can aid in the clinicopathologic diagnosis of granuloma annulare occurring at the site of prior herpes viral infection.
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Roger
R
Kapoor
Adriano
A
Piris
Arturo P
AP
Saavedra
Lyn M
LM
Duncan
Rosalynn M
RM
Nazarian
D003937:Diagnosis, Differential; D005260:Female; D015726:Giant Cells / Q000473:pathology; D016460:Granuloma Annulare / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D006562:Herpes Zoster / Q000150:complications*; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology