1
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Chandler DJ, Walker SL. HIV and skin infections. Clin Dermatol 2024; 42:155-168. [PMID: 38142787 DOI: 10.1016/j.clindermatol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
HIV infection alters the skin microbiome and predisposes to a wide range of cutaneous infections, from atypical presentations of common skin infections to severe disseminated infections involving the skin that are AIDS-defining illnesses. Bacterial infection of the skin, most commonly caused by Staphylococcus aureus, occurs frequently and can result in bacteremia. Nontuberculous mycobacterial infections that are usually localized to the skin may disseminate, and guidance on the treatment of these infections is limited. Herpes simplex can be severe, and less common presentations such as herpetic sycosis and herpes vegetans have been reported. Severe herpes zoster, including disseminated infection, requires intravenous antiviral treatment. Viral warts can be particularly difficult to treat, and in atypical or treatment-resistant cases a biopsy should be considered. Superficial candidosis occurs very commonly in people living with HIV, and antifungal resistance is an increasing problem in non-albicans Candida species. Systemic infections carry a poor prognosis. In tropical settings the endemic mycoses including histoplasmosis are a problem for people living with HIV, and opportunistic infections can affect those with advanced HIV in all parts of the world. Most cutaneous infections can develop or worsen as a result of immune reconstitution in the weeks to months after starting antiretroviral therapy. Direct microscopic examination of clinical material can facilitate rapid diagnosis and treatment initiation, although culture is important to provide microbiological confirmation and guide treatment.
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Affiliation(s)
- David J Chandler
- Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Aggarwal R, Spratt AR, Snow AL, Vignesh P. Epidermodysplasia Verruciformis in CADINS Disease: Expanding the Phenotype. J Clin Immunol 2024; 44:58. [PMID: 38311684 DOI: 10.1007/s10875-024-01663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Ridhima Aggarwal
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Alison R Spratt
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Room C-2013, Bethesda, MD, 20814, USA
| | - Andrew L Snow
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Room C-2013, Bethesda, MD, 20814, USA.
| | - Pandiarajan Vignesh
- Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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3
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Mohammad Deeb A, Mohammad Deeb E, Al-Soufi L. Epidermodysplasia verruciformis arising in a female with systemic lupus erythematosus: a rare case from Syria. Ann Med Surg (Lond) 2024; 86:1101-1105. [PMID: 38333298 PMCID: PMC10849436 DOI: 10.1097/ms9.0000000000001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 11/29/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Epidermodysplasia verruciformis is a rare autosomal recessive genodermatosis. Clinical manifestations might be helpful in the diagnosis of this disease. However, the final diagnosis is made after a genetic and histological study. Acquired epidermodysplasia verruciformis is a form of epidermodysplasia verruciformis described in patients with compromised cell-mediated immunity. Case presentation A 42-year-old female with a history of a pain and itch on the soles and palms started a year ago. There were multiple flat papules on the dorsal hands, scarring alopecia, malar rash, oral ulcers, Raynaud phenomenon, and palpable purpura. A histological examination confirmed the diagnosis of epidermodysplasia verruciformis. Clinical discussion Epidermodysplasia verruciformis is an uncommon disease that affects the immune system. The coexistence of systemic lupus erythematosus and epidermodysplasia verruciformis is rarely reported in the medical literature. This paper reports a rare case in which these two diseases have coexisted. Conclusion This publication aims to document this rare case and highlight the ideal criteria in diagnosing and treating epidermodysplasia verruciformis.
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Affiliation(s)
| | | | - Lina Al-Soufi
- Department of Dermatology, National Hospital of Latakia, Latakia, Syria
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4
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Gale A, Merzel Šabović EK, Kaiser DJ, Starbek Zorko M. Acquired epidermodysplasia verruciformis in a renal transplant patient: a case report. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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Kinariwalla N, Coromilas AJ, Garzon MC, Levin LE, Magro C, Lauren CT. Acquired epidermodysplasia verruciformis (AEV) in three children after cardiac transplantation: A case series and review of the literature. Pediatr Dermatol 2021; 38:1541-1545. [PMID: 34669978 DOI: 10.1111/pde.14701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acquired epidermodysplasia verruciformis (AEV) describes epidermodysplasia verruciformis developing in an immunocompromised host. There is limited information in the literature regarding AEV in the pediatric population; of the patients reported, most patients described had HIV, with only two reported cases of children who developed AEV post-transplantation. This case series describes three pediatric patients who developed AEV on immunosuppressant therapy following cardiac transplantation. We review risk factors, treatment options, and prognosis of AEV in the pediatric population.
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Affiliation(s)
- Neha Kinariwalla
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Alexandra J Coromilas
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Laura E Levin
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Cynthia Magro
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - Christine T Lauren
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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6
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Moore S, Rady P, Tyring S. Acquired epidermodysplasia verruciformis: clinical presentation and treatment update. Int J Dermatol 2021; 61:1325-1335. [PMID: 34403500 DOI: 10.1111/ijd.15857] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
Acquired epidermodysplasia verruciformis (AEV) is a form of epidermodysplasia verruciformis (EV) that is most commonly found in immunocompromised or immunosuppressed patients. EV is commonly associated with human papillomavirus (HPV), which is often found in EV and AEV lesions. Clinical presentation of AEV in patients with organ transplantation, HIV+, congenital HIV+, hematological diseases, and other iatrogenic immunosuppression are reviewed. Treatment options include topical cidofovir, topical retinoids, topical imiquimod, topical glycolic acid, HPV 9-valent vaccine, acitretin, improving cellular immunity, and changing transplant medication to mycophenolate mofetil.
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Affiliation(s)
- Stephen Moore
- Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA.,Rice University, Houston, Texas, USA
| | - Peter Rady
- Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Stephen Tyring
- Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
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7
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Gracia-Darder I, Montis Palos MC, Ramos D, Saus C, Escalas Taberner J, Del Pozo Hernando LJ. Acquired verruciform epidermodysplasia on a tattoo was successfully treated with photodynamic therapy. Photodiagnosis Photodyn Ther 2021; 34:102217. [PMID: 33592332 DOI: 10.1016/j.pdpdt.2021.102217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/16/2022]
Abstract
We present a 44-year-old man with multiple flat papules over a tattoo, diagnosed with acquired verruciform epidermodysplasia (EV). The lesions completely disappeared after 3 sessions of photodynamic therapy (PDT) with topical methyl aminolevulinate. PDT could be considered a treatment of choice in human papillomavirus lesions located over tattoos since it resolves the lesions while preserving the integrity of the design.
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Affiliation(s)
- Inés Gracia-Darder
- Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain.
| | | | - Daniel Ramos
- Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Carlos Saus
- Department of Pathology, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Juan Escalas Taberner
- Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
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8
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Wu CJ, Li X, Sommers CL, Kurima K, Huh S, Bugos G, Dong L, Li W, Griffith AJ, Samelson LE. Expression of a TMC6-TMC8-CIB1 heterotrimeric complex in lymphocytes is regulated by each of the components. J Biol Chem 2020; 295:16086-16099. [PMID: 32917726 DOI: 10.1074/jbc.ra120.013045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 09/09/2020] [Indexed: 11/06/2022] Open
Abstract
The TMC genes encode a set of homologous transmembrane proteins whose functions are not well understood. Biallelic mutations in either TMC6 or TMC8 are detected in more than half of cases of the pre-malignant skin disease epidermodysplasia verruciformis (EV). It is controversial whether EV induced by mutations in TMC6 or TMC8 originates from keratinocyte or lymphocyte defects. Quantification of TMC6 and TMC8 RNA levels in various organs revealed that lymphoid tissues have the highest levels of expression of both genes, and custom antibodies confirmed protein expression in mouse lymphocytes. To study the function of these proteins we generated mice with targeted deletion mutant alleles of Tmc6 or Tmc8 Either TMC6 or TMC8 deficiency induced a reduction in apparent molecular weight and/or amount of the other TMC molecule. Co-immunoprecipitation experiments indicated that TMC6 and TMC8 formed a protein complex in mouse and human T cells. MS and biochemical analysis demonstrated that TMC6 and TMC8 additionally interacted with the CIB1 protein to form TMC6-TMC8-CIB1 trimers. We demonstrated that TMC6 and TMC8 regulated CIB1 levels by protecting CIB1 from ubiquitination and proteasomal degradation. Reciprocally, CIB1 was needed for stabilizing TMC6 and TMC8 levels. These results suggest why inactivating mutations in any of the three human genes leads to similar clinical presentations. We also demonstrated that TMC6 and TMC8 levels are drastically lower and the proteins are less active in regulating CIB1 in keratinocytes than in T cells. Our study suggests that defects in lymphocytes may contribute to the etiology and pathogenesis of EV.
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Affiliation(s)
- Chuan-Jin Wu
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Xing Li
- Molecular Biology and Genetics Section, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Connie L Sommers
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Kiyoto Kurima
- Molecular Biology and Genetics Section, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Sunmee Huh
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Grace Bugos
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Lijin Dong
- Genetic Engineering Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wenmei Li
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Andrew J Griffith
- Molecular Biology and Genetics Section, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA
| | - Lawrence E Samelson
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA.
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9
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Combined pulsed dye laser and systemic retinoids for the treatment of hypertrophic resistant warts among organ transplant patients. Lasers Med Sci 2020; 35:1653-1657. [DOI: 10.1007/s10103-020-03011-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
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10
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Hu JK, Hornick N, Antaya RJ. Innumerable hypopigmented skin lesions in a 12-year-old girl with congenital HIV infection. Pediatr Dermatol 2020; 37:e20-e22. [PMID: 31997459 DOI: 10.1111/pde.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jamie K Hu
- School of Medicine, Yale University, New Haven, CT, USA
| | - Noah Hornick
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT, USA
| | - Richard J Antaya
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT, USA.,Department of Pediatrics, School of Medicine, Yale University, New Haven, CT, USA
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11
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Bassi A, Piccini P, Bianchi L, Montagnani C, de Martino M, Venturini E, Galli L. Diffuse hyperkeratotic lesions in a 4-year-old HIV-infected girl. Arch Dis Child 2019; 104:1228. [PMID: 30181128 DOI: 10.1136/archdischild-2018-315536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Andrea Bassi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Paola Piccini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Carlotta Montagnani
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elisbetta Venturini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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12
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Chen W, Zhao S, Zhu W, Wu L, Chen X. Retinoids as an Immunity-modulator in Dermatology Disorders. Arch Immunol Ther Exp (Warsz) 2019; 67:355-365. [PMID: 31552446 DOI: 10.1007/s00005-019-00562-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022]
Abstract
The skin is the largest epithelial surface protecting the body from invading microbes. Vitamin A plays vital roles in the host defence of the skin, including promoting epithelial cell integrity, proliferation, and differentiation and even mediating immune responses. Furthermore, vitamin A derivatives, retinoid drugs, are widely used to treat skin diseases, such as acne and psoriasis. However, the immunoregulatory mechanisms of retinoids in dermatology have not been systematically described. In this paper, we discuss the immunological functions of retinoids during disease treatment, especially in skin disorders caused by exogenous infections.
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Affiliation(s)
- Wangqing Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lisha Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, China.
| | - Xiang Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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13
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Bushara O, Miller D, Giubellino A, Schomaker M, Thyagarajan B, Nelson AC. Diagnosis of epidermodysplasia verruciformis: Two cases highlighting the role of direct HPV L1 gene sequencing. J Cutan Pathol 2019; 46:436-441. [PMID: 30773702 DOI: 10.1111/cup.13444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 01/21/2023]
Abstract
Epidermodysplasia verruciformis (EV) is a rare skin disease characterized by the development of multiple flat warts with the potential for malignant transformation. Patients are susceptible to human papillomavirus (HPV) infection that develops in a background of either a genetic or acquired immunodeficiency predisposing patients to infection with specific HPV types that are ubiquitous but generally non-pathogenic in healthy individuals. There is no standard clinical methodology for determining the causative HPV from patients with suspected EV. Here, we report the diagnostic workup of two EV cases and describe the use of L1 gene Sanger sequencing as a specific method to accurately identify the causative HPV genotype and confirm the diagnosis of EV.
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Affiliation(s)
- Omar Bushara
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Miller
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Schomaker
- Molecular Diagnostics Laboratory, MHealth University of Minnesota Medical Center-Fairview, Minneapolis, Minnesota
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Andrew C Nelson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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14
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Haley CT, Mui UN, Vangipuram R, Rady PL, Tyring SK. Human oncoviruses: Mucocutaneous manifestations, pathogenesis, therapeutics, and prevention: Papillomaviruses and Merkel cell polyomavirus. J Am Acad Dermatol 2018; 81:1-21. [PMID: 30502418 DOI: 10.1016/j.jaad.2018.09.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
In 1964, the first human oncovirus, Epstein-Barr virus, was identified in Burkitt lymphoma cells. Since then, 6 other human oncoviruses have been identified: human papillomavirus, Merkel cell polyomavirus, hepatitis B and C viruses, human T-cell lymphotropic virus-1, and human herpesvirus-8. These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. In addition, oncoviruses are associated with multiple benign mucocutaneous diseases. Research regarding the pathogenic mechanisms of oncoviruses and virus-specific treatment and prevention is rapidly evolving. Preventative vaccines for human papillomavirus and hepatitis B virus are already available. This review discusses the mucocutaneous manifestations, pathogenesis, diagnosis, treatment, and prevention of oncovirus-related diseases. The first article in this continuing medical education series focuses on diseases associated with human papillomavirus and Merkel cell polyomavirus, while the second article in the series focuses on diseases associated with hepatitis B and C viruses, human T-cell lymphotropic virus-1, human herpesvirus-8, and Epstein-Barr virus.
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Affiliation(s)
| | | | - Ramya Vangipuram
- Center for Clinical Studies, Webster, Texas; Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Peter L Rady
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephen K Tyring
- Center for Clinical Studies, Webster, Texas; Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
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15
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Epidermodysplasia Verruciformis-like HPV Infection of the Vulva in Immunosuppressed Women. Int J Gynecol Pathol 2018; 37:233-238. [PMID: 28700430 DOI: 10.1097/pgp.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The vast majority of vulvar human papilloma virus infections are produced by α human papilloma viruses and consist of exophytic or flat warts and classic or "usual" vulvar intraepithelial neoplasia. This report details 2 examples of epidermodysplasia verruciformis-like lesions of the vulva in women who were immunosuppressed. The most consistent morphologic feature was the presence of abnormal mature keratinocytes with large pale open nuclei with small nucleoli and eosinophilic cytoplasm, situated in the upper epithelial layers. In addition to these features, which are commonly seen in epidermodysplasia verruciformis-associated lesions, 1 case displayed in addition more extensively distributed abnormal nuclei, including involvement of both the upper epithelial strata and the epithelial/stromal interface. Both lesions were associated with β-papilloma virus type 5. The unique aspects of epidermodysplasia verruciformis-like lesions relative to the more common human papilloma virus infections of the vulva are highlighted and these cases illustrate the range of epithelial distribution that might be encountered in lesions involving the vulvar mucosa.
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16
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Schultz B, Nguyen CV, Jacobson-Dunlop E. Acquired epidermodysplasia verruciformis in setting of tumor necrosis factor-α inhibitor therapy. JAAD Case Rep 2018; 4:805-807. [PMID: 30246133 PMCID: PMC6141641 DOI: 10.1016/j.jdcr.2018.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Brittney Schultz
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.,Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Cuong V Nguyen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.,Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
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17
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Huang S, Wu JH, Lewis DJ, Rady PL, Tyring SK. A novel approach to the classification of epidermodysplasia verruciformis. Int J Dermatol 2018; 57:1344-1350. [PMID: 30156265 DOI: 10.1111/ijd.14196] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Epidermodysplasia verruciformis (EV) is a rare genodermatosis that causes disseminated eruptions of hypo- or hyperpigmented macules and wart-like papules that can coalesce and scale. It is uniquely characterized by an increased susceptibility to specific human papillomavirus (HPV) genotypes. Classically, EV is associated with mutations of the EVER1/TMC6 and EVER2/TMC8 genes. The term "acquired" epidermodysplasia verruciformis was coined to describe an EV-like syndrome that can develop in patients with a compromised immune system. Recent discoveries of other genes implicated in EV, including RHOH, MST-1, and CORO1A, have complicated the classification of EV and EV-like syndromes. METHODS We review the available data on epidermodysplasia verruciformis in the literature in order to propose a new classification system to encompass current and future developments on EV and EV-like syndromes. RESULTS We propose classifying EV into: (1) classic genetic EV, (2) non-classic genetic EV, and (3) acquired EV. CONCLUSION The proposed categorization scheme provides a simple and logical way to organize the different cases of EV that have been described in the literature. This system organizes EV by its cause, allowing for a better understanding of the disease and helps differentiate EV from other causes of generalized verrucosis.
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Affiliation(s)
- Simo Huang
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Julie H Wu
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel J Lewis
- School of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter L Rady
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen K Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA.,Center for Clinical Studies, Houston, TX, USA
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19
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de Jong SJ, Imahorn E, Itin P, Uitto J, Orth G, Jouanguy E, Casanova JL, Burger B. Epidermodysplasia Verruciformis: Inborn Errors of Immunity to Human Beta-Papillomaviruses. Front Microbiol 2018; 9:1222. [PMID: 29946305 PMCID: PMC6005841 DOI: 10.3389/fmicb.2018.01222] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/22/2018] [Indexed: 12/24/2022] Open
Abstract
Epidermodysplasia verruciformis (EV) is an autosomal recessive skin disorder with a phenotype conditional on human beta-papillomavirus (beta-HPV) infection. Such infections are common and asymptomatic in the general population, but in individuals with EV, they lead to the development of plane wart-like and red or brownish papules or pityriasis versicolor-like skin lesions, from childhood onwards. Most patients develop non-melanoma skin cancer (NMSC), mostly on areas of UV-exposed skin, from the twenties or thirties onwards. At least half of the cases of typical EV are caused by biallelic loss-of-function mutations of TMC6/EVER1 or TMC8/EVER2. The cellular and molecular basis of disease in TMC/EVER-deficient patients is unknown, but a defect of keratinocyte-intrinsic immunity to beta-HPV is suspected. Indeed, these patients are not susceptible to other infectious diseases and have apparently normal leukocyte development. In contrast, patients with an atypical form of EV due to inborn errors of T-cell immunity invariably develop clinical symptoms of EV in the context of other infectious diseases. The features of the typical and atypical forms of EV thus suggest that the control of beta-HPV infections requires both EVER1/EVER2-dependent keratinocyte-intrinsic immunity and T cell-dependent adaptive immunity.
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Affiliation(s)
- Sarah J de Jong
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York NY, United States
| | - Elias Imahorn
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Peter Itin
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia PA, United States
| | | | - Emmanuelle Jouanguy
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York NY, United States.,INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York NY, United States.,INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, Paris, France.,Howard Hughes Medical Institute, New York NY, United States
| | - Bettina Burger
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
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20
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Fouéré S, Aubin F, Péré H, Galicier L, Gheit T, Tommasino M, Ram Wolff C, Boutboul D, Bagot M. Epidermodysplasia verruciformis in an adult patient with a germline Interleukin-2 inducible T-Cell Kinase mutation and lymphoma: the case of inherited versus acquired. J Eur Acad Dermatol Venereol 2018; 32:e240-e241. [PMID: 29237091 DOI: 10.1111/jdv.14756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Fouéré
- STD Unit, Dermatology Department, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - F Aubin
- Dermatology Department, Centre Hospitalier Universitaire, 3 Boulevard Alexandre Fleming, 25030, Besançon, France
| | - H Péré
- Virology Department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - L Galicier
- Hematology and Immunology Department, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - T Gheit
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69008, Lyon, France
| | - M Tommasino
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69008, Lyon, France
| | - C Ram Wolff
- Dermatology Department, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - D Boutboul
- Hematology and Immunology Department, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M Bagot
- Dermatology Department, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
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21
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Collins MK, Peters K, English JC, Rady P, Tyring S, Jedrych J. Cutaneous squamous cell carcinoma with epidermodysplasia verruciformis-like features in a patient with Schimke immune-osseous dysplasia. J Cutan Pathol 2018; 45:465-467. [PMID: 29498428 DOI: 10.1111/cup.13139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/26/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Mary-Katharine Collins
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kaitlin Peters
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Rady
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephen Tyring
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jaroslaw Jedrych
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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22
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Beta Human Papillomavirus Infection Is Prevalent in Elephantiasis and Exhibits a Productive Phenotype: A Case-Control Study. Am J Dermatopathol 2017; 39:445-456. [PMID: 28253203 DOI: 10.1097/dad.0000000000000681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Elephantiasis is considered a cutaneous region of immune deficiency with cobblestone-like surface caused by a wart-like eruption. Verrucosis is a diffuse human papillomavirus (HPV) infection linked to immunodeficiency disorders. The objective of this study was to examine the prevalence of HPV infection in lymphedema and its pathogenic role in elephantiasis. A retrospective case-control study was performed examining lymphedematous skin and controls of peritumoral normal skin. HPV infection was evaluated at the DNA, protein, and histopathologic levels by polymerase chain reaction, immunohistochemistry, and light microscopy, respectively. Overall, 540 HPV DNAs were detected in 120 of 122 cutaneous samples (median 4 HPV DNAs per sample, range 0-9). Compared with controls, no differences existed in type or number of HPVs identified. Instead, a diverse spectrum of HPV-related histopathologies were evident, likely reflecting the multiplicity of HPV genotypes detected. Most notably, increasing histopathologic lymphedema stage significantly correlated with markers of productive HPV infection such as altered keratohyaline granules and HPV L1 capsid expression. Limitations of this study are the absence of normal skin controls not associated with neoplasia or subclinical lymphedema, and lack of assessment of HPV copy number per keratinocyte infected. In conclusion, productive HPV infection, not HPV type or numbers detected, distinguished lymphedematous skin from controls. These findings support the theory that lymphedema creates a region of depressed immunity that permits productive HPV infection, manifested clinically by diffuse papillomatosis, characteristic of elephantiasis.
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23
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Re-evaluation of epidermodysplasia verruciformis: Reconciling more than 90 years of debate. J Am Acad Dermatol 2017; 76:1161-1175. [PMID: 28196644 DOI: 10.1016/j.jaad.2016.12.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 12/31/2022]
Abstract
Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by abnormal susceptibility to cutaneous human beta-papillomavirus infections causing persistent flat warts or pityriasis versicolor-like lesions. This generalized verrucous skin disorder resembles generalized verrucosis, but these 2 conditions are distinguished by differences in clinical manifestation and the human papillomavirus types involved. A breakthrough in our understanding of EV was the discovery that homozygous inactivating mutations in TMC6 (EVER1) and TMC8 (EVER2) determine susceptibility to this disorder; however, they have not solved all EV cases fully. These deficiencies account for 75% of affected individuals, leaving a substantial number of patients without an underlying genetic cause. Recently, it has been revealed that mutations in additional genes (RHOH, MST-1, CORO1A, and IL-7) result in extensive human beta-papillomavirus replication and therefore manifest with an EV-like phenotype. The term "acquired EV" is used to describe an EV-like phenotype that develops in immunocompromised hosts, and the introduction of this entity further aggravates the confusion. Reevaluation of these entities is warranted. Here, we review the available data on this issue, provide up to date information on the major characteristics that differentiate between these seemingly clinically similar disorders, and highlight the different mechanisms involved in each disorder.
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24
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Hirschman D, Tacastacas J, Rady PL, Tyring SK, Cooper K, Honda K. Acquired Epidermodysplasia Verruciformis Associated with Human Papilloma Virus Type 14 in a Small Bowel Transplanted Child--A Case Report. Pediatr Dermatol 2016; 33:e1-5. [PMID: 26646304 DOI: 10.1111/pde.12734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 3-year-old African American girl taking sirolimus and tacrolimus for a small bowel transplantation presented with hypopigmented macules and papules throughout her trunk. A biopsy diagnosed epidermodysplasia verruciformis (EV) that was found to be associated with human papillomavirus (HPV) type 14 according to polymerase chain reaction analysis. There are few cases of acquired EV in the setting of organ transplantation. Although there is no standardized treatment for acquired EV, prevention and surveillance for transformation to squamous cell carcinoma are primary concerns.
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Affiliation(s)
- Derek Hirschman
- Graduate Medical Education Department, McLaren Bay Region, Bay City, Michigan
| | - Joselin Tacastacas
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Peter L Rady
- Center for Clinical Studies, University of Texas Health Science Center, Houston, Texas.,Department of Dermatology, University of Texas Health Science Center, Houston, Texas
| | - Stephen K Tyring
- Center for Clinical Studies, University of Texas Health Science Center, Houston, Texas.,Department of Dermatology, University of Texas Health Science Center, Houston, Texas
| | - Kevin Cooper
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Kord Honda
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
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25
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Champagne C, Moore L, Reule R, Dyer JA, Rady P, Tyring SK, North JP. Cornoid Lamella-Like Structures in HIV-Associated Epidermodysplasia Verruciformis: A Unique Histopathologic Finding. Am J Dermatopathol 2015; 37:929-32. [PMID: 26588337 PMCID: PMC4894799 DOI: 10.1097/dad.0000000000000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Epidermodysplasia verruciformis (EV) is an uncommon inherited skin condition with increased vulnerability to widespread infection by certain human papillomavirus types, resulting in extensive verruca plana-like papules coalescing to large confluent plaques. Since the AIDS epidemic starting in the 1980s, an acquired type of EV has been described in patients infected with human immunodeficiency virus. The histopathologic features of EV consist of papillated epidermal hyperplasia with hypergranulosis and a distinct bluish-gray color in the large human papillomavirus-infected keratinocytes in the stratum granulosum. The authors present a case of HIV-associated EV with a unique histopathologic finding of multiple cornoid lamella-like structures. To the authors' knowledge, this finding has not been previously described in the literature.
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Affiliation(s)
| | - Lindsey Moore
- Department of Dermatology, University of Missouri, Columbia, MO
| | - Ross Reule
- Department of Dermatology, University of Missouri, Columbia, MO
| | | | - Peter Rady
- Department of Dermatology, Laboratory for Molecular Studies in Mucocutaneous Diseases, University of Texas Health Science Center at Houston, Houston, TX; and
| | - Stephen K. Tyring
- Department of Dermatology, Laboratory for Molecular Studies in Mucocutaneous Diseases, University of Texas Health Science Center at Houston, Houston, TX; and
| | - Jeffrey P. North
- Departments of Dermatology, and
- Pathology, University of California, San Francisco, San Francisco, CA
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26
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Cougoul P, Tournier E, Delavigne K, Rauzy OB, Ysebaert L, Sibaud V. Acquired epidermodysplasia verruciformis, a new opportunistic infection related to bendamustine. Ann Hematol 2015; 94:1071-3. [DOI: 10.1007/s00277-015-2329-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
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27
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Cutaneous granulomas and epidermodysplasia verruciformis in early onset combined immunodeficiency syndrome. Am J Dermatopathol 2014; 36:179-83. [PMID: 24247584 DOI: 10.1097/dad.0b013e3182a67f9b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous granulomas with prominent caseating necrosis are a rare manifestation of immunodeficiency. Extensive and recalcitrant cutaneous viral infections can also be seen. We present a case of an 18-year-old white man with an early onset poorly characterized combined immunodeficiency syndrome who, over the past 5 years, developed enlarging tender red-purple plaques on his extremities and pink near-confluent macules on his chest and back. Previous biopsies of the red-purple plaques showed features of granuloma annulare. Histopathological examination of old and new biopsies revealed both sarcoidal and palisading necrobiotic granulomas with perforating features and elastophagocytosis. Stains and tissue cultures were negative for bacterial and fungal organisms. In addition, biopsy of a macule on the back demonstrated verruca plana with characteristics of epidermodysplasia verruciformis. As an infant, the patient had failure to thrive and a combined immunodeficiency, but was lost to follow-up for 15 years. He currently continues to have severe hypogammaglobinemia and cellular immunodeficiency. Intravenous immunoglobulin and prednisone were initiated and his plaques improved rapidly. Topical imiquimod was ineffective for the verruca plana. The patient and his parents are currently undergoing whole exome sequencing including evaluation for epidermodysplasia verruciformis 1 and 2 gene mutations. This case highlights the importance of including genetic immunodeficiency disorders in the clinical and histopathological differential diagnosis for cutaneous sarcoidal or palisading necrobiotic granulomas and for extensive cutaneous viral infection.
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28
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Jiyad Z, Ferguson JS, Ffolkes L, Greenblatt DT, Wee JS. Warty papules in a child with human immunodeficiency virus. Clin Exp Dermatol 2014; 39:952-4. [PMID: 25224962 DOI: 10.1111/ced.12436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Z Jiyad
- Department of Dermatology, St George's Hospital, London, UK
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