[CIS PIDD] Lichen planus

[Santhosh Kumar/FS/VCU]

Hello everyone,

Curious to know what the other immunologist around the world think of this case. 

Patient is a 64 year old African American lady with hx of lichen planus. It affects her oral cavity and vulvo-vaginal areas. Her vulvo-vaginal area is the worst affected. She has undergone multiple surgeries to keep the orifice open and currently is on Kenalog injection, locally and IM every few months. She came to me seeking as a last resort. I did a basic immune work up and her CBC, Immunoglobulins are within normal limits. Her lymphocyte enumeration is as below:
Absolute lymp- 1.9 10e9/L
CD2 %-           88 % H
CD2 Absolute-  1,672 /mm3
CD3 %-           80 %
CD3 Absolute-  1,520 /mm3
CD4 %-           67 % H
CD4 Absolute-  1,273 /mm3
CD8 %-           11 % L
CD8 Absolute-  209 /mm3
CD4/CD8-        6.1 H
CD19 %-          8 %
CD19 Absolute- 152 /mm3
CD56%-           13 %
CD56 Absolute-  247 /mm3 

Essential normal with slightly low percent CD 8 cells and high ratio. We know from studies that there is increased CD8+ T-cells in the lesional skin of lichen planus. Is there any value in pursuing any further work up (immune) for this patient. Any thoughts on treatment options.


Thank you,

Santhosh Kumar, MD
Assistant Professor,
Allergy & Immunology
Virginia Commonwealth University,
Richmond, VA
Ph-  804-628-1605
Fax-804-828-1751
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