Trichodysplasia spinulosa: rare presentation of polyomavirus infection in immunocompromised patients

Trichodysplasia spinulosa (TS) is a rare, striking, folliculocentric papular eruption seen exclusively in immunosuppressed patients. The eruption can be disfiguring, associated with leonine faces and alopecia. TS is caused by a polyomavirus, identified as trichodysplasia spinulosa polyomavirus (TSPyV). Few reports exist in the literature, and support for treatment options is sparse.

We report a patient with TS with underlying lupus nephropathy and renal transplant-associated immunosuppression. Diagnosis was confirmed by biopsy and pathognomonic histologic findings in the context of her extensive, spiculated monomorphous papules. With a biopsy-confirmed diagnosis, oral valganciclovir was prescribed, and the patient showed marked skin texture improvement and hair regrowth.

The continued reporting of cases of TS will improve clinical identification of this condition and provide better information regarding treatment and long-term consequences.