Dermatopathology
Human polyomavirus 6 and 7 are associated with pruritic and dyskeratotic dermatoses

https://doi.org/10.1016/j.jaad.2016.11.035Get rights and content

Background

Human polyomavirus (HPyV)6 and HPyV7 are shed chronically from human skin. HPyV7, but not HPyV6, has been linked to a pruritic skin eruption of immunosuppression.

Objective

We determined whether biopsy specimens showing a characteristic pattern of dyskeratosis and parakeratosis might be associated with polyomavirus infection.

Methods

We screened biopsy specimens showing “peacock plumage” histology by polymerase chain reaction for HPyVs. Cases positive for HPyV6 or HPyV7 were then analyzed by immunohistochemistry, electron microscopy, immunofluorescence, quantitative polymerase chain reaction, and complete sequencing, including unbiased, next-generation sequencing.

Results

We identified 3 additional cases of HPyV6 or HPyV7 skin infections. Expression of T antigen and viral capsid was abundant in lesional skin. Dual immunofluorescence staining experiments confirmed that HPyV7 primarily infects keratinocytes. High viral loads in lesional skin compared with normal-appearing skin and the identification of intact virions by both electron microscopy and next-generation sequencing support a role for active viral infections in these skin diseases.

Limitation

This was a small case series of archived materials.

Conclusion

We have found that HPyV6 and HPyV7 are associated with rare, pruritic skin eruptions with a distinctive histologic pattern and describe this entity as “HPyV6- and HPyV7-associated pruritic and dyskeratotic dermatoses.”

Section snippets

Methods

This was a retrospective case series of archived skin biopsy specimens. Histologically normal-appearing skin and archived biopsy samples were obtained through an institutional review board–exempt protocol. For patient B, written, informed consent was obtained for collecting skin swabs for diagnostic and research purposes.

Results

The clinical characteristics of the patients, which have been previously reported, are summarized in Table I.12, 13 All 3 patients presented with generalized, scaly, hyperpigmented papules coalescing into plaques, which were all present for at least 12 months. All dermatoses were associated with some degree of pruritus (Fig 1, A, and Table I). Although patient A was immunosuppressed from HIV that had progressed to AIDS, patient C was immunosuppressed from a kidney/pancreas transplant.

Discussion

Ho et al9 first associated HPyV7 infection with pruritic rashes in immunosuppressed transplant recipients with a characteristic peacock plumage histology. Our study confirms and extends these seminal findings by linking HPyV6 with similar rashes. This study also broadens the range of immunosuppressed states that may allow for HPyV7 infection from iatrogenic immunosuppression from organ transplantation to the immunocompromised state of HIV infection. Of note, the patient with HIV described here

References (21)

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    Citation Excerpt :

    Cutaneous manifestations associated with the Polyomaviridae include Merkel cell carcinoma, trichodysplasia spinulosa (TS), and, more recently, pruritic and dyskeratotic dermatosis (PDD). The viruses responsible for disease are Merkel cell polyomavirus, TS-associated polyomavirus, human polyomavirus 6 (HPyV6), and human polyomavirus 7 (HPyV7).1-3 We report a patient with an unusual presentation of PDD that included a lichenified dermatosis associated with alopecia and follicularly-based keratotic papules.

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Supported by the National Institutes of Health (National Cancer Institute Intramural Research Program to Dr Buck and K08 CA164047 to Dr Wang), a Burroughs Wellcome Fund Career Award for Medical Scientists (1010978) to Dr Wang, and a Disease-Oriented Clinical Scholar Awards to Dr Wang.

Conflicts of interest: None declared.

Reprints not available from the authors.

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