Polyomavirus Associated Trichodysplasia Spinulosa in a Pediatric Kidney Transplant Recipient

Trichodysplasia spinulosa (TS) is an inconspicuous cutaneous infection caused by a distinct polyoma virus affecting the immunocompromised host. TS is rare in children and can masquerade as other dermatological conditions, causing a delay in diagnosis. There is a lack of evidence regarding standard treatment guidelines due to the rarity of the condition.

Here, we report a case of TS in a 10-year-old girl who underwent a deceased donor kidney transplant and later developed spiculated white papules over her entire body.

A definitive diagnosis of TS was made by skin biopsy, showing TS in the hair follicle. Paraffin scrolls of the specimen were positive for trichodysplasia spinulosa polyomavirus small T antigen viral gene. The patient was successfully treated with a reduction in immunosuppression and the addition of leflunomide and valganciclovir. She remained negative for BK virus in the serum and did not develop rejection of her graft.

This case demonstrates a rare infectious complication following pediatric solid organ transplantation and highlights the extensive distribution and slow response to ultimately successful treatment of TS with timely reduction in immunosuppression. However, the role of valganciclovir remains uncertain in the management.