A Rare Case of Transient Acantholytic Dermatosis (AKA. Grover’s Disease) with Concomitant Pediculosis Pubis: An Atypical Presentation and First Documented Case Report

Abstract

A 66-year-old male presented with a one-month history of persistent pruritic eruptions distributed mainly on the trunk. A punch biopsy from the left upper abdomen revealed focal acantholytic dyskeratosis with mixed inflammatory infiltrate in the dermis composed of numerous eosinophils. Grover’s disease was diagnosed based on the clinical and histopathological findings. Appropriate treatment was initiated but failed to relieve symptoms of itchiness. A further investigation of the hair follicles under mineral oil preparation revealed an infestation of pediculosis pubis. Subsequent treatment with Ivermectin and permethrin cream led to the complete resolution of his symptoms. This case report highlights an unusual and first documented case of Grover’s disease with a concomitant infestation of pediculosis pubis. To date, no reported cases in the literature have associated Grover’s disease with pubic lice infestation. However, there are three reported cases of concurrent scabies and Grover’s disease in the literature. This rare case underscores the clinical value in further investigating treatable underlying conditions in patients with suspected transient acantholytic dermatosis.

The nit sheath: A rare histopathologic clue for the diagnosis of louse infestation

“…Skin biopsy is typically not required for the diagnosis of louse infestation, and the histopathologic findings are mostly non‐specific, showing a typical arthropod assault response with a wedge‐shaped infiltrate of lymphocytes and eosinophils as well as dermal hemorrhage 7 . A recently‐reported case describes a patient with biopsy‐confirmed transient acantholytic dyskeratosis (Grover disease) who failed standard treatment and experienced improvement in his pruritic symptoms only upon discovery and appropriate treatment of a concomitant pubic lice infestation 8 . This could suggest louse infestation as a possible trigger or exacerbating factor for Grover disease.…”

“…7 A recentlyreported case describes a patient with biopsy-confirmed transient acantholytic dyskeratosis (Grover disease) who failed standard treatment and experienced improvement in his pruritic symptoms only upon discovery and appropriate treatment of a concomitant pubic lice infestation. 8 This could suggest louse infestation as a possible trigger or exacerbating factor for Grover disease. Identification of an eosinophilic sheath around a hair shaft should raise suspicion for louse infestation.…”