Epidermodysplasia verruciformis‐like syndrome in association with systemic lupus erythematosus

Abstract

A 43 year-old immunosuppressed woman presented with a widespread macular scaly rash, clinically and histologically consistent with epidermodysplasia verruciformis. She had no family history of epidermodysplasia verruciformis. Human papillomavirus typing was performed on both biopsied skin from clinical lesions and on plucked body hairs. The lesional skin from the arm and knee showed predominantly human papillomavirus-20 and -47 respectively. Human papillomavirus genotyping from the hair follicles revealed that human papillomavirus-20 had the highest viral load, irrespective of body site.

Acquired Epidermodysplasia Verruciformis: A Comprehensive Review and a Proposal for Treatment

“…Recently an EV‐like syndrome has been described in patients with impaired cell‐mediated immunity, and the term “acquired EV” has been introduced. This form has been described in immunosuppressed patients with the human immunodeficiency virus; organ transplantation; lepromatous leprosy; Hodgkin's disease; systemic lupus erythematosus; common variable immunodeficiency; warts, immunodeficiency, lymphedema, anogenital dysplasia syndrome (WILD syndrome); immunoglobulin M deficiency; and adult T‐cell leukemia and in the setting of graft‐versus‐host disease . Treatment with biological agents may also increase the risk of HPV infections, including acquired EV …”

Epidermodysplasia-Verruciformis-Like Eruption Associated with Gamma-Papillomavirus Infection in a Patient with Adult T-Cell Leukemia

“…Although in most cases clinical and histological features of the warts [17,42,43,46,47,48] and the associated HPV types [17,46,48] in immunosuppressed patients do not differ from those in the general population, rare cases of acquired EV-like eruption have been reported in immunosuppressed patients, including patients with organ transplants [15,16,17,18,19], lepromatous leprosy [49], Hodgkin lymphoma [20], systemic lupus erythematosus [21,22], human immunodeficiency virus infection [19,23,24,25,26,27,28,29,30,31,32,33,34,50,51], severe combined immune deficiency caused by γc or JAK3 deficiency after hemopoietic stem cell transplantation [35], and in the setting of graft-versus-host disease [36]. Treatment with biological agents may also increase the risk for HPV infections including acquired EV [52].…”

“…Therefore, β-papillomaviruses may be commensals of the human skin and harmless for the general population, although their roles in the development of nonmelanoma skin cancers, particularly in immunosuppressed patients, have been suggested [12,13,14]. In addition, acquired EV-like eruption associated with β-papillomavirus infection has occasionally been described in immunosuppressed patients [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]. …”

The transmembrane channel-like protein family and human papillomaviruses

“…Compared with primary EV, however, EV-HIV patients appear to have lower rates of malignant transformation, possibly due to the rarity of EV in this population. EV and EV-like syndromes have also been described in organ transplant recipients 58 , 59 and in systemic lupus erythematosus 60 . Of note, immunosuppression per se is insufficient for the initiation and/or maintenance of EV-HPV pathogenesis or oncogenesis, as there is a lack of persistent cutaneous lesions with high levels of EV-HPV DNA replication among patients with genetic, acquired, or iatrogenic depression of CMI.…”