Virus-Associated Trichodysplasia Spinulosa

Department of Dermatology, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
American Journal of Surgical Pathology (Impact Factor: 4.59). 03/2005; 29(2):241-6. DOI: 10.1111/j.0303-6987.2005.0319l.x
Source: PubMed

ABSTRACT Virus-associated trichodysplasia spinulosa (VATS) is a cutaneous eruption of spiny papules predominantly affecting the face that is associated with a distinctive histologic picture of abnormally maturing anagen follicles with excessive inner root sheath differentiation and hyperkeratotic infundibula. Ultrastructurally, intranuclear viral particles consistent with polyoma virus are found. Only 2 patients have thus far been reported. Both had developed the eruption after a kidney transplant. We report 2 additional cases of VATS. One is an 8-year-old boy who presented with facial papules after a kidney transplant. The other is a 19-year-old man with a history of acute lymphocytic leukemia who never had a transplant. He developed a papular facial eruption as well as alopecia. Light microscopic and ultrastructural examinations revealed a spectrum in the severity of the histologic alterations as well as the number of intranuclear viral particles. This report expands the range of pathologic alterations associated with VATS and documents for the first time that it can affect patients without a solid organ transplant. The similarity of the clinical and histologic features of VATS with those previously reported by others as cyclosporine-induced "follicular dystrophy" or "pilomatrix dysplasia" raises the possibility that the described phenomena may reflect the same entity. Increased awareness of the distinct histologic picture associated with VATS will likely lead to more frequent diagnosis of this underrecognized entity.

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    ABSTRACT: , Department of Applied Mathematics, Tongji University, Shanghai, China Taught: Complex Analysis, Differential Geometry, and Calculus 1985--1988 Assistant, Department of Applied Mathematics, Tongji University, Shanghai, China Taught: Linear Algebra, Analytic Geometry, and Calculus Affiliations SIAM IEEE & IEEE Computer Society American Mathematical Society Mathematical Association of America Honors 1992--1993 Graduate Fellowship, Center for Applied Mathematics, University of Notre Dame 1989--1990 Graduate Fellowship, Department of Mathematics, University of Notre Dame Selected Publications 1. "Spectra and Pseudospectra of Block Toeplitz Matrices", with A. Lumsdaine, Linear Algebra and its Applications, 1997, accepted. 2. "Spectra and Pseudospectra of the Waveform Relaxation Operators", with A. Lumsdaine, SIAM Journal on Scientific Computing, Vol. 18, No. 1, January 1997. 3. "On the Integral R
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    ABSTRACT: We report two boys with trichodysplasia spinulosa associated with chemotherapy for acute lymphocytic leukaemia. Trichodysplasia spinulosa is a cutaneous viral infection of immunosuppressed patients that causes abnormal hair follicle maturation. Our patients presented with widespread papules, some extruding a central keratin spicule, which were most prominent on the face. Histopathology demonstrated hair follicles dilated by a proliferation of large eosinophilic cells containing numerous abnormal trichohyaline granules. Electron microscopy in case 1 revealed 30-nm viral particles in the stratum corneum consistent with a papovavirus. In case 1, the eruption persisted despite topical salicyclic acid 4%, ammonium lactate 17.5%, tretinoin 0.05% and oral acitretin. However, it resolved once the patient's immune function returned to normal (total duration of 2 years). In case 2, the eruption spontaneously resolved after 9 months. This case report discusses the characteristic clinicopathological features of trichodysplasia spinulosa and, for the first time, follows the condition's natural history.
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    ABSTRACT: Viral-associated trichodysplasia is a recently described entity associated with immunosuppression. We describe a 68-year-old man with a history of treated lymphoma who developed numerous, disfiguring, papular and spiny lesions involving most of the central face. Both facial and body alopecia was noted. Histopathologic findings of a facial papule showed dramatic alterations of the hair bulbs, including bulbar distention, lack of hair shaft formation and a marked expansion of inner root sheath type epithelium. These findings were identical to those of previously described cases, so electron microscopy was performed. Numerous intranuclear virus particles were identified. Shortly after the diagnosis of trichodysplasia was made, the patient was found to have a relapse of his lymphoma, which may represent the source of his immunosuppression. Based on his skin biopsy findings, successful antiviral therapy was initiated. This case and a review of previously reported cases are discussed in this study.
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