Abstract

CASE REPORT ON PITYRIASIS LICHENOIDES ET VARIOLIFORMIS ACUTA

*Anna B. Varghese and Sneha Lissue Antony

Abstract

Background: Pityriasis Lichenoides et Varioliformis Acuta (PLEVA) is a rare inflammatory skin disorder characterized by the sudden onset of erythematous papules that may undergo necrosis or ulceration. While generally self-limiting, severe cases can present with systemic involvement, posing diagnostic challenges and requiring a multidisciplinary approach. Case Presentation: A male patient presented with a one-month history of painful, erythematous, and black-colored lesions over the bilateral thighs, upper and lower limbs, trunk, scalp, and ankles, associated with mild itching. Lesions began on the left shin and progressively spread to other areas. Some lesions developed central necrosis within two days. The patient also reported bilateral pedal edema and severe pain in the lower limbs. There was no history of fever, recent drug intake, or systemic prodrome. A punch biopsy from the left thigh was performed. Key Findings: Biopsy confirmed the diagnosis of PLEVA. Blood pressure was elevated and managed with antihypertensives including Amlodipine, Cilacar, Nebivolol, and supportive medications. Cardiology evaluation showed good biventricular systolic function with no RWMA. Ophthalmologic examination revealed a single dot hemorrhage, likely secondary to hypertension. Surgery consultation was sought for severe lower limb pain, edema, and suspected PVOD. The patient was treated with systemic corticosteroids (Inj. Betnesol), antibiotics (Ciplox TZ, Metrogyl), antiplatelets (Ecosprin), vasodilators (Isordil), and Pentoxiphyllin. Conclusion: This case highlights an unusual, extensive presentation of PLEVA with systemic symptoms requiring a multidisciplinary approach. Early diagnosis through biopsy and prompt supportive care are essential to prevent complications and ensure optimal patient outcomes.

Keywords: Pityriasis Lichenoides et Varioliformis Acuta, necrotic skin lesions, punch biopsy, systemic symptoms.