10.5826/dpc.1303a166
text/xml
2160-9381
3117
en
James  Dekay
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Trichodysplasia Spinulosa in a 71-year-old Heart Transplant Recipient
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-12-31
2023-07-31
2023-08-24
e2023166
Dermatol Pract Concept
James  Dekay
2023/07/31
10.5826/dpc.1303a166
e2023166
Maine General Medical Center, Augusta, ME
2160-9381
en
e2023166
Haycox CL, Kim S, Fleckman P, et al. Trichodysplasia spinulosa--a newly described folliculocentric viral infection in an immunocompromised host. J. Investig. Dermatol. Symp. Proc. 1999;4(3):268-271.
Trichodysplasia Spinulosa in a 71-year-old Heart Transplant Recipient
https://dpcj.org/index.php/dpc/article/download/3117/2236
             Trichodysplasia Spinulosa in a 71-Year-Old
                     Heart Transplant Recipient
                               Maulik M Dhandha1, Debjit Ghosh2, James Dekay3


1 Woodland Clinic - Dignity Health, Woodland, CA
2 MGL Group, Rajkot, India
3 Maine General Medical Center, Augusta, ME



Citation: Dhandha MM, Ghosh D, Dekay J. Trichodysplasia Spinulosa in a 71-Year-Old Heart Transplant Recipient. Dermatol Pract
Concept. 2023;13(3):e2023166. DOI: https://doi.org/10.5826/dpc.1303a166
Accepted: January 25, 2023; Published: July 2023
Copyright: ©2023 Dhandha et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Maulik M Dhandha, MD, Woodland Clinic, 632 W Gibson Road, Woodland, CA. E-mail: maulikdhandha@gmail.com




Case Presentation                                                        scaly erythematous plaques on scalp, eyebrows, chin, upper
                                                                         cutaneous lip and nose (Figure 1). Skin biopsy showed di-
A 71-year-old Caucasian male with a past medical history                 lated and distorted follicles with absent hair shaft and ex-
of heart transplant approximately 18 months ago, on tac-                 pansion of the matrix from the inner root sheath and outer
rolimus and prednisone presented with chief complaints                   root sheath with dense keratohyalin granules (Figure 2),
of redness on the face and hair loss on the eyebrows and                 which are concerning for trichodysplasia spinulosa (TS).
mustaches. On examination, he had small spicules overlying




                                                                         Figure 2. Histopathology showing dilated and distorted follicles
Figure 1. Small spicules overlying thin erythematous plaque on the       with absent hair shaft and expansion of the matrix from the inner
right ala.                                                               root sheath and outer root sheath with dense keratohyalin granules.



Image Letter | Dermatol Pract Concept. 2023;13(3):e2023166                                                                                1
    The patient was given an oral valganciclovir low dose of 450   ulerythema ophryogenes, follicular-based graft versus host
mg daily.At follow up in 4 weeks, the erythema and spicules were   disease.
significantly decreased. He continued the regimen for another          Trichodysplasia spinulosa polyomavirus (TSPyV) infects
4 weeks and only had minimal erythema and spicules re-             the skin, but in asymptomatic cases the viral DNA is rarely
maining. Given his history of chronic kidney disease, val-         found even if the individuals possess antibodies to the virus.
ganciclovir was stopped with caveat to restart it for short        As it is a rare disease, there is no gold standard treatment
duration as needed.                                                available till date, but TS has to be timely diagnosed other-
                                                                   wise it may develop into leonine facies [2].

Teaching Point
                                                                   References
TS is a rare dermatological condition which was first re-
ported in the year 1995, and named later in the year 1999.          1. Curman P, Nasman A, Brauner H. Trichodysplasia spinulosa:
                                                                       A comprehensive review of the disease and its treatment. J Eur
TS is often known as an emerging infectious disease.
                                                                       Acad Dermatol Venereol. 2021;35(5):1067-1076. DOI: 10.1111/
However, the cases of TS may rise due to the increase in
                                                                       jdv.17081. PMID: 33559344. PMCID: PMC8247895.
the number of patients on immunosuppressive drug regi-              2. Haycox CL, Kim S, Fleckman P, et al. Trichodysplasia spinulosa--a
mens [1]. Differential diagnosis for TS includes trichosta-            newly described folliculocentric viral infection in an immuno-
sis spinulosa, follicular hyperkeratotic spicules associated           compromised host. J Investig Dermatol Symp Proc. 1999;4(3):
with multiple myeloma, lichen spinulosus, spiky follicular             268-271. DOI: 10.1038/sj.jidsp.5640227. PMID: 10674379.

mycosis fungoides, disseminated spiked hyperkeratosis,




2                                                                         Image Letter | Dermatol Pract Concept. 2023;13(3):e2023166
