Ulcerative and erosive (mucocuteaneous) lichen planus associated with persistent chronic hepatitis and pancytopenia
Erosive and ulcerative lichen planus is a rare variant of a disease characterised by erosive lesions of the mucous and, more rare, by ulcerative palmoplantar injuries.
Female patient, 54 years old, urban area, is submitted due to leukoplakia and erosive oral lesions, papulosquamous lesions of palms and soles, periungual ulcerations on feet and nails changes on the left hallux. The affection began two months ago with the appearance of the palmoplantar and digital lesions. It wasn't observed the oral involvement which wasn't accompanied by subjective symptomatology. From the personal case history we note persistent chronic hepatitis, arterial high blood pressure, evolving for the last 10 years. The general clinic examination and the one with the help of devices show splenomegaly and arterial values of 200/90 mmHg.
The local exam:
Violaceous flat-topped polygonal, shiny papules aggregated in small plaques on the abdomen sides and in the axillary area. At the level of the wrist there are papules of bigger dimensions. On palms and soles there are grouped and singulaire papulosquamous lesions, having thick adherent scale, while periungular and towards the apex of the toes we notice irregular ulcerative lesions.
The nail of the left hallux is partially destroyed, at its base being only a thin remnant from the plate. Leukoplakia and oral erosive lesions.
Severe pancytopenia, the slight increase of the direct bilirubin and the decrease of the seric iron. Hbs antigen, anti-Hbc and anti-HVC anticorps are negative. The abdominal ultrasound shows the liver as being in the superior limits of the normal values and splenomegaly. Sternal puncture shows a hipoplasic marrow with the erythroblastic series having a hipochromic aspect, the granulocytic series as being hipoplasic and the megakaryocytic series being poor. The puise therapy with dexamethasone which was recommended for pancitopenia continued after that with prednisone, and the topic treatment with mometasone furoate have led to a spectacular amelioration of the cutaneous and mucous lesions.
The case particularity: the presence of mucous erosions and cutaneous ulcerations and of the association with other autoimmune manifestations.