د.بــــشــــرى عبد الرحمن المقرمي

A woman in her 60s presented w/ a several-wk hx of eruptive asymptomatic blanchable vascular papules on the face, chest, back, & UEs. She denied pruritus, pain, bleeding, or systemic sx. O/E: numerous lesions composed of a central erythematous papule w/ radiating telangiectasias. No jaundice, palmar erythema, ascites, hepatomegaly, or other stigmata of CLD. PMH -ve for liver dz, EtOH misuse, pregnancy, estrogen use, endocrinopathy, CTD, or hereditary vascular syndromes. She has been taking a CCB for HTN x10 yrs. CBC, CMP, LFTs, coagulation studies, thyroid/hormonal testing, & imaging were unremarkable. What’s the diagnosis❓

What's the diagnosis❔

Human polyomavirus 7 (HPyV7)-associated dermatosis. HPyV7-associated dermatosis is a rare eruption seen in immunosuppressed solid-organ transplant recipients. It typically presents as pruritic violaceous-brown scaly macules & thin velvety plaques involving the trunk, axillae, & extremities. Histopath characteristically shows dyskeratotic keratinocytes w/ columnar/tiered parakeratosis ("peacock plumage"), & dx is confirmed by tissue PCR demonstrating HPyV7. In this patient, the combination of chronic intensified immunosuppression following liver transplantation, the characteristic distribution & morphology of the eruption, supportive histopathologic findings, & +ve tissue PCR established the diagnosis of HPyV7-associated dermatosis. Reduction of immunosuppression remains the cornerstone of therapy. Low-dose acitretin has shown benefit in several reported cases and was associated with near-complete clearance in this patient, leaving only residual post-inflammatory hyperpigmentation after prolonged treatment. DDx: acanthosis nigricans, confluent and reticulated papillomatosis (CARP), pityriasis versicolor, lichen planus pigmentosus, post-inflammatory hyperpigmentation, erythema dyschromicum perstans (ashy dermatosis), papular acantholytic dyskeratosis / Grover disease, chronic graft-versus, cutaneous T-cell lymphoma (mycosis fungoides), epidermodysplasia verruciformis, and other viral-associated dermatoses in immunocompromised hosts.

An immunosuppressed elderly woman presented w/ a 1-yr hx of a large painful pigmented lesion on the right plantar foot. Dermoscopy demonstrated a parallel ridge pattern w/ diffuse irregular pigmentation. What’s the diagnosis❔