Pigmented Purpuric Dermatoses (PPD) Associated with Radiologically Isolated Syndrome (RIS): Is There a Relationship?

Thursday, June 2, 2016
Exhibit Hall
Jay H Rosenberg, MD , Staff Physician MS Center of Southern CA, Carlsbad, CA
Michael Zorniak, Ph.D. , MSL at Teva Pharmaceuticals, San Diego, CA


Pigmented Purpuric Dermatoses (PPD) is a group of benign and chronic dermatological disorders of unknown etiology that are characterized by extravasation of erythrocytes and deposition of hemosiderin. They are pathologically described as a T cell dyscrasia in the superficial blood vessels of the skin. Could this dermatological T cell disorder be involved in the genesis of RIS?


To demonstate through a case report of the possibility that Radiologically Isolated Syndrome (RIS) could possibly be linked to dermatological T cell disorder.


This is a single case report of a 23 y.o. woman who was seen at the age of 12 and 13 by dermatology and at the age of 23 by neurology.  


She first experienced severe lesions of PPD at the age 12 and 13 responding to steroids.  She subsequently has experienced very tiny lessons on and off since.  At age 23, migraine resulted in the obtaining of a MRI scan of the brain.  This demonstrated  multiple white matter lesions non-hemorrhagic located both juxtacortical and periventricular with a quarter size enhancing lesion in the left frontal temporal area.  MRI of the cervical spine with and without contrast was negative for any abnormality.  Cerebral spinal fluid analysis was positive for oligoclonal bands.  However, she did not have one symptom and her neurological examination on several occasions has remained completely normal.  Review of the literature looking for associations of PPD with CNS demyelination failed to show any prior cases of RIS, Clinically Isolated Syndrome (CIS), or Clinically Definite MS (CDMS).  Therefore, this is the first case of PPD associated with RIS.  Since PPD is a T cell dyscrasia, the extravasation of skin T cells may be associated with the development of immune mediated CNS radiographic lesions and demyelination.  


This is the first case report of a documented potential linkage between PPD and RIS.