Diffuse Large B-Cell Lymphoma at the Site of a Herpes Zoster Scar

Rana M. Mays, Rajini K. Murthy, Rachel A. Gordon, Whitney J. Lapolla, Sarah K. Galfione, Amy A. Hassan, Ronald P. Rapini, Carolyn A. Bangert, Stephen K. Tyring

Abstract


Herpes zoster, also known as shingles, occurs upon reactivation of a primary infection with varicella zoster virus (VZV). Risk factors for reactivation include stress, older age, and immunosuppression, all of which are associated with a decrease in host immunity. Common complications of herpes zoster include scarring and post-herpetic neuralgia (PHN). Cutaneous lesions such as granuloma annulare, lymphomas, and sarcoid granulomas have also been reported to potentially arise at the site of herpes zoster. Here, we report a case that to our knowledge is the first presentation of diffuse large B-cell lymphoma with its only cutaneous manifestation arising in a herpes zoster scar. Punch biopsy was performed on a nodule appearing in a dermatomal distribution within the herpes zoster scar. Histopathology revealed an atypical lymphoid infiltrate in the dermis that was determined to be CD20 positive B-cells. Immunostains for CD20, CD79a, and PAX-5 showed strong positive staining of the atypical cells, confirming B-cell origin and resulting in the diagnosis of lymphoma, large B-cell type. This case highlights the importance of raising clinical suspicion for a malignant process in patients who present with a changing or unresolving skin manifestation after infection with varicella zoster virus.




doi: http://dx.doi.org/10.4021/wjon531w

Keywords


Herpes zoster; Varicella zoster virus; Diffuse large B-cell lymphoma

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