Virus-Associated Trichodysplasia Spinulosa

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.

Viral-Associated Trichodysplasia

“…3–5,8,9,11,17 Also, sequencing of PCR products confirmed the presence of the human polyomavirus TSV, as reported previously. 2,3 Unique to this report is the immunohistochemical identification of the human polyomavirus middle T antigen corresponding to large eosinophilic cellular inclusions in keratinocytes of the inner root sheath, which were visualized on both vertical and horizontal sections.…”

Trichodysplasia spinulosa is characterized by active polyomavirus infection

“…13,15,[23][24][25][26]31 However, despite terminology differences, all cases represented immunocompromised patients that had follicular papules and spiny lesions on the face histologically characterized by enlarged, dysmorphic hair follicles consisting of IRS cells packed with trichohyalin. By assembling the first representative series of TS samples from almost half of all previously described cases grouped under different names, we provided evidence that these patients indeed suffered from the same disease with TSPyV infection as a shared feature.…”

“…1B). 24,26 These cells also contained electron-dense cytoplasmic protein accumulations, probably trichohyalin. 15,27,28 …”

“…1,13,15,16,19,[23][24][25] To verify TS in the unpublished cases (Table 1), histology was performed on TS4, TS5 and TS6. H&E staining of these samples showed enlarged hair follicles with numerous IRS cells containing large cytoplasmic eosinophilic granules (Fig.…”

Merkel Cell Carcinoma: A Virus-Induced Human Cancer

“…VATS is a rare, nonneoplastic disorder that manifests with hyperkeratotic spinous papules of the face and is observed exclusively in posttransplant and immunosuppressed individuals. On the basis of this association with immunosuppression and ultrastructural detection of polyomavirus-like particles (31), van der Meijden and colleagues (30) applied RCA to VATS spicules to find trichodysplasia spinulosum polyomavirus (TSaPyV). More recently, fluids and tissues from immunosuppressed patients were screened by consensus PCR, and a ninth human polyomavirus (HPyV9) was found in kidney secretions (32).…”