Double Trouble With Zoster: Report of Lichenoid and Granulomatous Dermatitis Following Reactivated Varicella Zoster Infection and Review of Literature.

Abstract: Lichenoid and granulomatous dermatitis is an uncommon cutaneous reaction pattern, which combines features of lichenoid and granulomatous inflammatory patterns. It can represent an idiopathic lichenoid eruption or be associated with a variety of disorders including drug reactions, hepatobiliary disorders, rheumatoid arthritis, infections, tattoo reactions, pigmented purpuric dermatosis, lichenoid contact dermatitis, and cutaneous T-cell lymphoma. Clinical manifestations include pruritic, pink to violaceous, macules, papules, plaques, or nodules, with or without scaling, usually distributed on the trunk and extremities. In this article, we present a case of a 70-year-old woman with a history of rheumatoid arthritis and diabetes mellitus who developed a pruritic rash within the exact distribution of a preceding varicella zoster infection. Histopathology showed a dense lymphocytic lichenoid interface dermatitis with superficial and deep perivascular lymphocytic and granulomatous inflammation, consistent with the diagnosis of lichenoid and granulomatous dermatitis. The patient was started on a topical steroid and at 3-month follow up, demonstrated significant improvement of the skin lesions.