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Key Clinical Message: Mycosis fungoides is a diagnostic challenge. Herein, we report a case with marked lichenoid features in pathology assessments. After several biopsies and clinicopathologic correlation, the diagnosis of lichenoid mycosis fungoides was made., Abstract: Mycosis fungoides (MF) is a great imitator and mimicks other dermatoses clinically and histopathologically. We report a 61-year-old patient with 5-year history of generalized violaceous patches and plaques. His biopsy revealed a marked lichenoid band-like infiltrate of inflammatory cells along the basal layer with basal layer vacuolar changes; the diagnosis of lichen planus was first made histopathologically. Several biopsy specimens, clinicopathologic correlation, and immunohistochemistry findings confirmed the diagnosis of lichenoid MF. Awareness of peculiar histopathologic findings of MF is essential to avoid a potential misdiagnosis. When in doubt, multiple biopsies with other diagnostic methods should be employed., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Key Clinical Message: There is a need to pay more attention to cutaneous leishmaniasis in endemic regions which may mimic other dermatoses and treatment should be initiated with a strong clinical suspicion even without any histopathologic or PCR confirmation to avoid disfigurement or development of secondary malignancy., Abstract: Leishmaniasis is a vector-borne disease with a variety of Clinical manifestations. Cutaneous leishmaniasis (CL) is the most common form of disease and can mimic other dermatoses. We describe two unusual cases of chronic leishmaniasis that remained undiagnosed for many years and led to superimposition of squamous cell carcinoma (SCC) on lesions of one patient. These reports showed that the leishmaniasis should be borne in mind by clinicians when encountering any infiltrated lesion in patients from endemic regions and treatment should be initiated with a strong clinical suspicion even without any histopathologic or PCR confirmation to avoid disfigurement or development of secondary malignancy., Competing Interests: The authors declare that they have no conflict of interest regarding the publication of this article., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Key Clinical Message: The immunosuppressant agents should be considered earlier in the course of treatment with rituximab, possibly after the unfavorable response at first cycle of treatment, especially in male patients and those with high BMI., Abstract: Rituximab (RTX) has recently been proposed as an alternative first-line therapy for pemphigus patients. However, there are some rare reports of worsening of pemphigus following RTX therapy in the literature. This study aimed to evaluate the efficacy and safety of using a combination treatment of mycophenolate mofetil or dapsone and methotrexate in case of nonresponse, exacerbation or development of allergic reactions following rituximab therapy in pemphigus patients. In this case series, archive files of pemphigus patient in a tertiary care hospital from 2016 to 2021 who were treated with rituximab were reviewed and those with failure in treatment process including nonresponsiveness, exacerbation or development of allergic reactions to rituximab were identified and assessed. The study includes five patients out of 1245 RTX-treated patients, who did not respond to RTX (one patient) or experienced an exacerbation of disease (two patients) or development of allergic reactions (two patients). Male patients with high BMI (BMI > 25) whose response to rituximab was not good at first cycle and happened to receive rituximab later in the course of disease, had highest number of relapses and benefited the most from this combination immunosuppressive treatment as an alternative for repeating rituximab cycles. The lower risk of relapse and a better chance of remission might indicate the efficacy of adjuvant immunosuppressant therapy in patients with no-response, exacerbation, or allergic reaction to rituximab. These therapeutic effects were better observed in patients who received lower doses of rituximab which could suggest that the immunosuppressant agents should be considered earlier in the course of the disease, possibly after the first failed trial of rituximab therapy., Competing Interests: All the authors declare that there is no conflict of interest., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Sarcoidosis is an inflammatory and granulomatous disorder, developed due to dysregulation between immune response and certain environmental antigens. We hereby report an interesting case of sarcoidosis following COVID-19 vaccination (COVIran Barekat), which presented with inflammation of previous tattoo sites as well as the development of erythema nodosum and systemic lymphadenopathy, suggested a possible link between the COVID vaccination and dysregulation of the inflammatory process and served as a reminder for clinicians to have enough vigilance before proposing a vaccine booster to these patients., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Development of pemphigus foliaceus (PF) following SARS-CoV-2 infection has only been reported in one patient who had received Bamlanivimab and thus might be considered as a drug-induced case of PF. Here, we reported the first case of PF arising solely after COVID infection without taking any culprit drug., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Although the presence of morphea following COVID-19 has been rarely reported, the development of its generalized form following COVID-19 vaccination has not been reported yet. Here, we reported the first case of generalized morphea following COVID-19 vaccination and another similar case following SARS-Cov-2 infection. Other etiologic factors were also dealt with., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Cases of filler reactions after COVID-19 vaccination have been reported. Here, we present the first case of delayed-type reaction (DTR) to non-hyaluronic acid Polycaprolactone dermal filler after the second dose of Sinopharm COVID-19 vaccine which was improved with administration of topical and intralesional steroids., Competing Interests: None to declare., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Coronavirus disease 2019 (COVID-19) vaccines significantly impacted world health and well-being. However, various adverse events have been observed following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Cutaneous reactions have been prevalent following many vaccines, including COVID-19 vaccines. Here, we present a case of new-onset lichen planus in a patient who received the COVID-19 vaccine at the same time as being infected with SARS-CoV-2. A 52-year-old woman presented to the clinic with extensive pruritic skin lesions. The eruptions had appeared a week after her second dose of the Sinopharm COVID-19 vaccine. She mentioned a history of SARS-CoV-2 infection approximately 10 days following the first dose of her vaccine, causing a 1-month delay in getting the second dose. Her past medical history was not significant. On examination, erythematous and squamous papules were demonstrated predominantly on the extremities, including inguinal and axillary folds. Moreover, desquamation of the lips was visible, and buccal lesions were also found. After consultation with a dermatologist, a skin biopsy was indicated for the patient, but she refused to undergo the procedure. Therefore, considering the typical appearance of the eruptions, lichen planus was suspected, for which she was treated with oral antihistamines and topical corticosteroids., Competing Interests: The authors declare that they have no conflict of interest., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Herpes Zoster caused by reactivation of latent Varicella-Zoster virus (VZV). The rare disseminated form of it occurred mainly in immunocompromised patients. We hereby present the first case of atypical disseminated herpes zoster in a 54-year-old woman admitted with serious COVID. In this case, disseminated herpes zoster developed by purpuric lesions mimicking vasculitis and cutaneous drug reaction. Hence, this case serves as a reminder for considering atypical presentations of cutaneous disorders in immunocompromised patients, especially those affected with severe COVID., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)