Herpetic Infection Overlying Pigmented Bowen’s Disease Resulting in Diagnostic Pitfall: A Case Report

confused with several benign and malignant dermatological diseases. Superimposed infections may further confuse the picture and cause some very difficult diagnostic problems. Case Presentation: A case of a 63 year old man with a pigmented lesion over the right, low abdomen, which had been present for 3 years. The lower half of the lesion has recently developed presenting with burning pain and erosions there necessitating medical consultation. The initial punch biopsy specimen showed features consistent with viral dermatitis with herpetic cytopathic changes with multinucleated keratinocytes, ballooning degeneration and intra-nuclear inclusions. There was no definite sign of malignancy. But due to the continuing clinical suspicion, given the longstanding pigmented plaque, a repeat biopsy was performed from a representative site. Biopsies revealed full thickness epidermal dysplasia with irregular acanthosis and atypical keratinocytes typical of Bowen's disease with secondary inflammatory changes. The finding of superadded herpetic infection to the underlying neoplastic process was suggested with the previous biopsy. Conclusion: This case illustrates the rare occurrence of herpetic infection and pigmented Bowen's disease that occurred simultaneously, and the need for a clinic-pathological correlation when the clinic-pathologic presentation does not otherwise fully explain the clinic-pathological diagnosis, as well as a recommendation to repeat biopsy in such persistent and suspicious lesions.

Keywords: Bowen's disease, Pigmented Bowen's disease, Herpetic infection, Viral dermatitis, Squamous cell carcinoma in situ, Diagnostic pitfall.