Giant cell lichenoid dermatitis

Area of Science:

• Dermatology
• Immunology
• Pathology

Background:

• Systemic lupus erythematosus (SLE) management can involve various medications.
• Drug-induced hypersensitivity reactions can manifest with diverse dermatological symptoms.
• Lichenoid dermatitis is an inflammatory skin condition characterized by specific microscopic features.

Observation:

• A 52-year-old woman with steroid-dependent systemic lupus erythematosus developed a generalized papulosquamous pruritic eruption.
• The patient was concurrently taking methyldopa and chlorothiazide for hypertension.
• The eruption significantly improved upon cessation of these antihypertensive agents and initiation of topical corticosteroids.

Findings:

• Microscopic examination revealed a lichenoid inflammatory pattern in the skin lesions.
• Key findings included epidermotropic multinucleated giant cells, cytoid bodies, and a mixed chronic inflammatory infiltrate (lymphocytes, histiocytes, eosinophils).
• This specific inflammatory response was considered unusual for drug-induced lichenoid dermatitis.

Implications:

• This case suggests that methyldopa and chlorothiazide can potentially induce lichenoid dermatitis.
• The presence of epidermotropic multinucleated giant cells represents an atypical inflammatory response in this context.
• Dermatologists should consider antihypertensive medications as potential causative agents in patients presenting with lichenoid eruptions, especially those with underlying autoimmune conditions.