Cutaneous lupus after herpes zoster: isomorphic, isotopic, or both?

Koebner isomorphic response describes the phenomenon of histopathologically identical skin lesions of a preceding cutaneous disease appearing in sites of trauma. Wolf isotopic response describes the phenomenon of a new skin disease appearing in the site of an unrelated cutaneous disease. Neither of the phenomena has been reported in relation to systemic lupus erythematosus. This report describes a 17-year-old girl with systemic lupus erythematosus exhibiting particularly severe cutaneous involvement confined primarily to sun-exposed areas presenting with a dermatomal band of atrophic, scaling, erythematous papules, and plaques on her left shoulder extending down her left arm after herpes zoster eruption. The histopathologil result showed lupus erythematosus. This phenomenon is best considered as a Koebner isomorphic response, although Wolf isotopic response has some clinical relevance as well. Koebner isomorphic and Wolf isotopic responses are discussed as related to this case.

Subacute cutaneous lupus erythematosus and interstitial myositis occurring with hepatitis B infection: response to antiviral therapy with lamivudine.

Lupus erythematosus (LE) is a multisystem inflammatory disease resulting from an altered T- and B-cell response. Among various pathogenic factors, viral infections have been implicated in LE exacerbation. We describe a patient with acute onset of subacute cutaneous lupus erythematosus (SCLE) and interstitial myositis with mitochondrial changes in the context of an associated hepatitis B infection and the response of myositis to antiviral treatment with lamivudine. Viral vectors may play an important role in LE. A hitherto undescribed myositis with mitochondrial changes was associated with hepatitis B infection and SCLE and improved with antiviral treatment.

Identification of retroviral DNA sequences in serum of cutaneous forms of lupus erythematosus patients.

Discoid (DLE), discoid disseminated (DDLE) and subacute cutaneous lupus erythematosus (SCLE) are recognised as cutaneous forms of lupus erythematosus (LE). It has been suggested that expression of endogenous retroviral components might induce the biosynthesis of antiDNA antibodies in LE patients. Using the dot blot hybridisation, we detected the greatest correlation between biosynthesis of anti-double stranded DNA (anti-dsDNA), anti-single stranded DNA (anti-ssDNA) antibodies and the presence of human immunodeficiency virus type I (HIV-1) pol sequences in DNA isolated from serum of SCLE (n = 22) patients. The same studies conducted in the groups of DLE (n = 85) and DDLE (n = 51) patients, exhibited a lower correlation between production of anti-dsDNA, anti-ssDNA and the presence of homologous HIV-1 pol sequences than in SCLE patients. Our findings suggest that the presence of endogenous retroviral sequences in patient serum may exhibit a relationship with development of cutaneous forms of LE disease.

Lupus erythematosus-like features in patients with cutaneous T-cell lymphoma.

BACKGROUND: The development of lupus erythematosus-like (LE-like) features in patients with cutaneous T-cell lymphoma (CTCL) has not been reported previously in the literature. Both diseases, however, have been etiologically linked to retroviruses. OBJECTIVE: Our purpose was to report four cases of patients with CTCL who developed LE-like features during the course of their disease, and to evaluate for evidence of antibodies to retroviruses in the sera of these patients. PATIENTS: Four patients with biopsy-proven CTCL with clinical or histologic features of systemic lupus erythematosus (SLE) were evaluated for clinical and laboratory criteria for SLE. Only one patient demonstrated four American Rheumatism Association (ARA) criteria sufficient for the diagnosis of SLE. The remaining three patients demonstrated one or two criteria for SLE. In addition, the sera of these patients were examined by Western blot analysis for evidence of human immunodeficiency virus type I (HIV-I), human T-cell lymphotrophic virus type I (HTLV-I), or human intracisternal A-type particle type I (HIAP-I) retroviral proteins. Each patient demonstrated antibodies to some of the retroviral proteins examined. The sera of two patients reacted to proteins for HIAP-I, and the sera of two patients reacted to p24 gag proteins of HIV-I. No patient reacted to HTLV-I proteins. CONCLUSIONS: Our report identifies four patients with CTCL who developed LE-like features during the course of their disease. Although the etiology of CTCL and SLE has not been well established, each has been linked to retroviruses. Evidence of antibodies to retroviral proteins was identified in each of our patients by Western blot analysis. Although the clinical and laboratory findings in these cases do not resolve the etiologic role of retroviruses in CTCL or SLE, they suggest that retroviruses may have a role in the pathogenesis of the clinical phenomenon reported in these four patients.

Prevalence of human herpesvirus 8 infection measured by antibodies to a latent nuclear antigen in patients with various dermatologic diseases.

BACKGROUND: Human herpesvirus 8 (HHV-8) has been detected in all epidemiological forms of Kaposi sarcoma (KS). The role of HHV-8 in dermatologic diseases other than KS is controversial. Some studies based on polymerase chain reaction findings suggest an association between HHV-8 and epithelial tumors of the skin, lymphoproliferative disorders, or pemphigus. OBJECTIVE: To assess the prevalence of antibodies against a latent nuclear antigen of HHV-8 in patients with various dermatologic diseases. DESIGN: An indirect immunofluorescence assay was used to search for HHV-8 antibodies. SETTING: Ambulatory or hospitalized patients from a university hospital associated with a research laboratory. PATIENTS: Eighty-three patients with various non-KS dermatologic diseases and 16 patients with KS who were seronegative for the human immunodeficiency virus. Controls were 100 healthy subjects living in the same area. RESULTS: Antibodies to HHV-8 were found in 100% (16/16) of the patients with KS and 3.6% (3/83) of the patients with non-KS dermatologic diseases: 1 patient with pemphigus vulgaris, 1 with discoid lupus erythematosus, and 1 with bullous pemphigoid. The prevalence of antibodies to HHV-8 in controls was 2% (2/100) and was not significantly different than the prevalence in patients with dermatologic diseases other than KS (P =.28). CONCLUSIONS: Our serologic study confirms the higher prevalence of HHV-8 antibodies in patients with KS and demonstrates that contrary to other human herpesviruses, HHV-8 is not a ubiquitous virus in France. We could not determine any causal association between HHV-8 and pemphigus or lymphoproliferative disorders of the skin.