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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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2
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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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3
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Henning A, Weaver J, Reedy M. Acquired Epidermodysplasia Verruciformis in the Setting of Renal Transplant. Am J Dermatopathol 2021; 43:71-74. [PMID: 32568838 DOI: 10.1097/dad.0000000000001696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Epidermodysplasia verruciformis (EV) is a rare dermatologic condition that is clinically characterized by flat, cutaneous, verrucous papules, pityriasis versicolor-like lesions, and similar lichenoid papules. There are 2 forms of EV: a classic inherited genodermatosis and a secondary acquired form. EV predisposes individuals to infections with certain types of human papillomavirus virus and subsequently increases the risk of cutaneous squamous cell carcinoma. The acquired form occurs in immunosuppressed patients, particularly in patients infected with HIV; however, it has also been described in patients who have undergone stem cell and solid organ transplantation. We report an additional case of renal transplantation and immunosuppressive therapy-associated acquired EV (AEV) in a 78-year-old man with multiple flesh-colored to violaceous, flat-topped papules distributed on the face and trunk clinically mimicking lichen planus. Biopsy was typical for that of EV, demonstrating enlarged keratinocytes with a blue-gray cytoplasm, a thickened granular layer, acanthosis, and hyperkeratosis. Herein, we discuss an unusual presentation of an AEV-mimicking lichen planus with review of the literature.
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Affiliation(s)
- Ania Henning
- Department of Pathology and Laboratory Medicine, Summa Health System- Akron, Akron, OH; and
| | - Joshua Weaver
- Department of Pathology and Laboratory Medicine, Summa Health System- Akron, Akron, OH; and
| | - Matthew Reedy
- Trillium Creek Dermatology and Surgery Center, Medina, OH
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4
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Gara S, Jones M, Litaiem N, Hedri H, Rammeh S, Zeglaoui F. Acquired epidermodysplasia verruciformis in renal-transplant recipients. Clin Case Rep 2020; 8:2678-2681. [PMID: 33363803 PMCID: PMC7752617 DOI: 10.1002/ccr3.3251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022] Open
Abstract
Acquired epidermodysplasia verruciformis in renal-transplant recipients is associated with a high risk for developing squamous cell carcinoma. An accurate diagnosis and a regular monitoring in this high-risk population must be stressed.
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Affiliation(s)
- Soumaya Gara
- Department of DermatologyCharles Nicolle HospitalTunisTunisia
| | - Meriem Jones
- Department of DermatologyCharles Nicolle HospitalTunisTunisia
| | | | - Hafedh Hedri
- Department of NephrologyCharles Nicolle HospitalTunisTunisia
| | - Soumaya Rammeh
- Department of PathologyCharles Nicolle HospitalTunisTunisia
| | - Faten Zeglaoui
- Department of DermatologyCharles Nicolle HospitalTunisTunisia
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5
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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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6
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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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7
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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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Perianal Epidermodysplasia Verruciformis Associated With Human Papillomavirus 5 After a Renal Transplant. J Low Genit Tract Dis 2018; 21:e35-e36. [PMID: 28504981 DOI: 10.1097/lgt.0000000000000316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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9
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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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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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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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