Wolf's isotopic phenomenon: a case report

Abstract

Introduction: Wolf’s isotopic phenomenon consists on the development of a dermatosis at the site of a previous, unrelated, and already healed skin lesion. In most cases, the first skin disease is a Herpes infection. The isotopic response can have several clinical presentations.

Material and methods: Case report

Results: We describe the case of 75-year-old female patient that presented appearance of erythematous papules in her right frontal and periorbital areas. The patient had a previous history of ophthalmic Herpes Zoster infection 3 months before, on the same location. The patient referred past chronic lymphocytic leukemia, currently in remission. A biopsy of the skin lesion was then performed, which revealed a diffuse nodular infiltration of the dermis, with small irregular lymphocytes. Immunohistochemical analysis was positive for CD5+, CD20+ and CD23+, consistent with the diagnosis of skin infiltration with chronic lymphocytic leukemia.

Conclusions: Wolf’s isotopic phenomenon is a very rare and underdiagnosed clinical entity.

Key words: Wolf’s isotopic phenomenon; Isotopic response; Herpes Zoster