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Acta Derm Venereol 95 © 2014 The Authors. doi: 10.2340/00015555-1937 Journal Compilation © 2015 Acta Dermato-Venereologica. ISSN 0001-5555 A 38-year-old woman was referred to our dermatology clinic with a 6-month history of erythematous plaques on her torso. Despite partly severe pruritus, the skin lesions were largely asymptomatic and the patient’s general condition was good. The patient reported a vacation in South America prior to the emergence of the skin alterations. The woman suffered from epilepsy, which had been treated continuously for 15 years with the same combined therapy regimen (sodium valproate 500 mg twice daily and phenytoin 100 mg in the morning and 150 mg at night). Physical examination revealed 6 isolated, non-scaling erythematous-to-brownish plaques on the upper back, around the neckline and the chest (Fig. 1). Basic laboratory tests (complete blood count, basic metabolic panel) were normal. Histopathology revealed a dense, subepidermal, band-like lymphocytic infiltrate. Discrete, focal epidermotropism was seen without formation of Pautrier microabscesses (Fig. 2). The infiltrate consisted of small lymphocytes without striking polymorphism admixed with histiocytes. Immunophenotyping revealed an overall mixed-cell infiltrate, predominantly consisting of CD3+ and CD4+ T lymphocytes as well as CD20+ and CD79a+ B lymphocytes. CD79a+ cells accounted for 10–20% of the infiltrate. Both biopsies revealed a clonal rearrangement of the T-cell receptor-γ-gene. |
