title: Herpes zoster granulomatous dermatitis: histopathologic findings in a case series.
abstract: Several types of cutaneous reactions have been reported to arise at the site of herpes zoster (HZ) infection weeks to years after the acute disease. Among these, granulomatous reactions are the most frequently reported. In this study, we describe the spectrum of histopathologic findings of HZ granulomatous reactions observed in 26 patients with cutaneous lesions confined to the area of previous HZ eruption and compare them with biopsy specimens taken from 25 patients with acute HZ. All patients with persistent reactions from whom history was available presented within 12 weeks of the onset of the acute eruption. The most frequent findings were interstitial granulomatous dermatitis with lymphocytes, histiocytes and multinucleated giant cells displaying elastophagocytosis and a perineural, perivascular and perieccrine mononuclear inflammatory infiltrate rich in lymphocytes and plasma cells. Less common features included intra-arrector and peri-arrector pili granulomas, follicular dilatation and hyperkeratosis, and vasculitis. Specimens from patients with acute HZ were found to have small numbers of perineural plasma cells and most had subtle granulomatous inflammation, in patterns similar to the group with late granulomatous reactions. Our findings suggest that granulomatous reactions to varicella zoster virus represent a persistent evolving inflammatory reaction after acute infection.
authors.affiliation: Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Katalin
authors.initials: K
authors.lastname: Ferenczi
authors.affiliation: Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Rosenberg
authors.affiliation: Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Timothy H
authors.identifier: http://orcid.org/0000-0002-8102-3348
authors.initials: TH
authors.lastname: McCalmont
authors.affiliation: Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Kwon
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
authors.affiliation: Departments of Dermatology and Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Somach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003872:Dermatitis / Q000473:pathology* / Q000821:virology; D005260:Female; D015726:Giant Cells / Q000473:pathology; D006099:Granuloma / Q000473:pathology / Q000821:virology*; D006562:Herpes Zoster / Q000473:pathology* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification*; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010950:Plasma Cells / Q000473:pathology; D012189:Retrospective Studies; D014657:Vasculitis / Q000473:pathology / Q000821:virology; D055815:Young Adult
keywords: granuloma; inflammation; zoster