Epidermodysplasia verruciformis in Lepromatous Leprosy

Jacyk, W.K.; Lechner, W.

doi:10.1159/000249701

Cited by 19 publications

(10 citation statements)

References 8 publications

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“…However, in this case, the patient did not block the HPV infection but reacted efficiently to M. leprae. The converse situation to our case report (two African sisters suffering from lepromatous leprosy who had EV) has already been described [15]. In contrast to tuberculosis, clinical leprosy does not appear more frequently in immunosuppressed individuals such as HIV-positive subjects [7].…”

Section: Discussionsupporting

confidence: 60%

Clinical presentation of tuberculoid leprosy in an epidermodysplasia verruciformis patient

Prestes-Carneiro

Nai

Silva

et al. 2011

J Infect Dev Ctries

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Epidermodysplasia verruciformis (EV) is triggered by a variety of mechanisms that at least partly include genetic background. We present a Brazilian man with a 30-year history of flat, wart-like lesions with clinical, histopathological, and evolutive aspects consistent with papillomavirus (HPV)-associated EV. Histological analysis of the wart lesions showed epidermis with hyperkeratosis, regular acanthosis, hypergranulosis, and cells with abundant basophilic cytoplasm. Moreover, a perivascular lymphocytic infiltrate was found in the superficial dermis, consistent with a viral wart. Type-2-HPV DNA was detected in various fragments of skin-wart lesions using the polymerase chain reaction (PCR). Two years after the EV diagnosis, the patient presented with an anesthetic well-demarcated, erythematous and mildly scaly plaque on his right forearm. A histopathological analysis of this lesion demonstrated the presence of a compact tuberculoid granuloma. ZiehlNeelsen staining demonstrated the presence of rare acid-fast bacilli and confirmed the tuberculoid leprosy diagnosis. The patient's Mitsuda Intradermal Reaction was positive. To elucidate the possible mechanism involved in this case of EV, we genotyped the HLA genes of this patient. DQB genotyping showed the polymorphic HLA alleles DQB1*0301 and 0501. The patient was treated with a paucibacillary multidrug therapy scheme, and the disease was cured in six months. This report describes an EV patient with an M. leprae infection, confirming that tuberculoid leprosy patients possess a relatively specific and efficient cell-mediated immunity against the bacillus and, therefore, localized forms of the disease. Moreover, we show the possible involvement of the polymorphic HLA alleles DQB1*0301 and 0501 in EV induction mechanisms.

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Section: Discussionsupporting

confidence: 60%

Clinical presentation of tuberculoid leprosy in an epidermodysplasia verruciformis patient

Prestes-Carneiro

Nai

Silva

et al. 2011

J Infect Dev Ctries

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“…HPV 5,8,9,12,14,15,17,[19][20][21][22][23][24][25][36][37][38]47,49). [34][35][36] However, a susceptibility locus to EV mapped to chromosome 17qter region, 37 frequent coinfection with HPV 3, 38 and the rarity of EV-like eruptions in immunodeficient states [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] indicate that other, nonimmunological factors operate in the development of clinically diagnosable EV infection. None the less, defects of cellmediated immunity such as CD4 lymphopenia in this case, or cutaneous anergy, decreased response to T-cell mitogens (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…large granular CD8+ lymphocytes are common to immunocompromised patients with EV-like eruptions. [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] Idiopathic CD4 lymphopenia (persistent CD4 counts < 300 mm )3 and ⁄ or < 20% of the total T cells in the absence of HIV 1 ⁄ 2 or HTLV 1 ⁄ 2 infection 56 ) has been associated with extragenital HPV 18-positive bowenoid papulosis 57 and verrucosis, [58][59][60][61] but not EV-like eruptions. Rarely, cutaneous epidermoid cysts exhibit signs of HPV infection and are often termed verrucous cysts.…”

Section: Discussionmentioning

confidence: 99%

Recurrent 'sterile' verrucous cyst abscesses and epidermodysplasia verruciformis-like eruption associated with idiopathic CD4 lymphopenia

Tobin¹,

Rohwedder

Holland

et al. 2003

Br J Dermatol

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Rupture of follicular (epidermoid) cysts is believed to be the consequence of bacterial infection. We report a 24-year-old man with idiopathic CD4 lymphopenia and chronic Mycobacterium avium intracellulare infection who developed multiple, recurring painful abscesses over the distal extremities that increased in number and severity when systemic steroid and interferon-gamma treatment was instituted for interstitial lung disease. Cultures were consistently negative for microorganisms, but pathological examination revealed ruptured epidermoid cyst walls with human papillomavirus (HPV) viropathic changes (keratinocytes with perinuclear halos and abundant basophilic keratohyaline granules). Cutaneous examination showed numerous, widespread flat-topped papules and achromic macules over the extremities, head and neck. Nested polymerase chain reaction analysis for HPV DNA revealed that the abscess-related cyst walls harboured epidermodysplasia verruciformis (EV)-associated HPV types 20, 24, alb-7 (AY013872) and 80. His cutaneous lesions harboured HPV types 3, 8 and 80. Similar to past reports, our patient developed an EV-like eruption in the setting of immunodeficiency. In this instance, EV-associated HPV infection of the follicular infundibular epithelium or pre-existing cysts in the setting of immunodeficiency may have led to cystic growth, rupture and subsequent painful inflammation.

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“…Recently an EV‐like syndrome has been described in patients with impaired cell‐mediated immunity, and the term “acquired EV” has been introduced. This form has been described in immunosuppressed patients with the human immunodeficiency virus; organ transplantation; lepromatous leprosy; Hodgkin's disease; systemic lupus erythematosus; common variable immunodeficiency; warts, immunodeficiency, lymphedema, anogenital dysplasia syndrome (WILD syndrome); immunoglobulin M deficiency; and adult T‐cell leukemia and in the setting of graft‐versus‐host disease . Treatment with biological agents may also increase the risk of HPV infections, including acquired EV …”

mentioning

confidence: 99%

Acquired Epidermodysplasia Verruciformis: A Comprehensive Review and a Proposal for Treatment

Zampetti

Giurdanella

Manco

et al. 2013

Dermatologic Surgery

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Epidermodysplasia verruciformis in Lepromatous Leprosy

Cited by 19 publications

References 8 publications

Clinical presentation of tuberculoid leprosy in an epidermodysplasia verruciformis patient

Clinical presentation of tuberculoid leprosy in an epidermodysplasia verruciformis patient

Recurrent 'sterile' verrucous cyst abscesses and epidermodysplasia verruciformis-like eruption associated with idiopathic CD4 lymphopenia

Acquired Epidermodysplasia Verruciformis: A Comprehensive Review and a Proposal for Treatment

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