Virus‐Associated Trichodysplasia Spinulosa

Background:  Virus‐associated trichodysplasia spinulosa (VATD) is a relatively new entity associated with a distinctive histologic picture of distended follicles with excessive production of inner root sheath material. Only two patients have thus far been reported. Both had developed the condition after a kidney transplant. Observation: We report two additional cases of VATD. One is a nineteen year‐old man with a history of acute lymphocytic leukemia, who developed a papular facial eruption as well as madarosis. The other is a nine year‐old boy, who presented with facial papules after a kidney transplant. Histologic examination of both cases reveals characteristic findings for trichodysplasia spinulosa, but also indicates a spectrum of histologic alterations. Ultrastructural studies confirm the presence of a variable number of intranuclear viral particles. Conclusions: Our cases illustrate the histologic spectrum seen in association with VATD. The severity of histologic alterations corresponds to the viral load seen by electron microscopy. This report documents for the first time that VATD can be found in patients without a solid organ transplant. Increased awareness of the distinct histologic picture associated with VATD will likely lead to more frequent diagnosis of this under‐recognized entity.