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Epidermodysplasia verruciformis in the setting of graft-versus-host disease.

Kunishige JH, Hymes SR, Madkan V, Wyatt AJ, Uptmore D, Lazar AJ, Giralt S, Rady P, Tyring S

Department of Dermatology, University of Texas-Health Science Center at Houston, Houston, Texas, USA.

We report a case of epidermodysplasia verruciformis (EV)-like lesions in a patient with graft-versus-host disease after peripheral blood stem cell transplantation from his HLA-matched brother. The patient presented with a diffuse papular eruption that was clinically consistent with graft-versus-host disease; however, histopathology demonstrated viral cytopathic changes and polymerase chain reaction confirmed EV human papillomavirus types 8 and 20. Repeated biopsy specimen showed both human papillomavirus cytopathic effect and graft-versus-host disease, and further workup revealed ocular and hepatic involvement. This progressed to a lupuslike syndrome with lichenoid, violaceous, flat-topped papules in a malar distribution and positive antinuclear autoantibodies. Although EV-like lesions have been reported in patients who are immunocompromised, the incidence is low, and may be linked to EV-related haplotypes.

Published 16 October 2007 in J Am Acad Dermatol, 57(5): S78-80.
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