Max Fischer

Specific detection of trichodysplasia spinulosa–associated polyomavirus DNA in skin and renal allograft tissues in a patient with trichodysplasia spinulosa

BACKGROUND Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition that affects immunosuppressed patients, universally involving the central face. New data point to the recently discovered TS-associated polyomavirus (TSPyV) as the causative agent. OBSERVATIONS We report a case of TS in a 48-year-old African American man after renal transplant; via polymerase chain reaction and sequencing, confirm the detection of TSPyV in lesional skin; and report the novel detection of TSPyV DNA in renal allograft tissue. Results of polymerase chain reaction analysis were negative for Merkel cell polyomavirus in lesional skin. Fifteen months later, urine cytologic findings showed morphologic evidence of a urinary tract polyomavirus infection. Results of SV40 immunohistochemical analysis were negative in lesional skin, renal allograft, and urine specimens. CONCLUSIONS To our knowledge, this is the first reported case in which TSPyV DNA has been detected in extracutaneous tissues and the third with combined ultrastructural and molecular confirmation of the presence of TSPyV in lesional skin. Lack of detection of other pathogenic human polyomaviruses in this patients skin supports the specific role of this polyomavirus in the genesis of TS. Further basic science studies are needed to determine the exact pathomechanisms of this polyomavirus and to explore possible tumorigenic roles in other skin diseases.

Establishing telepathology in Africa: Lessons from Botswana

Few reports of telepathology in Africa exist in the medical literature. With the strong need for improvement in health care infrastructure and personnel training in many African nations, telepathology provides a rapid and versatile tool to improve clinical care and foster educational and research opportunities. We describe the challenges faced in establishing robotic telepathology (RT) services at a government referral center in Botswana and reflect on conditions under which such initiatives may be most likely to succeed in sub-Saharan Africa and other parts of the developing world.

Vesicular Lesions on the Vulva—Quiz Case

A54-year-oldwomanpresentedwithanapproximately2-year history of lesions in the vulvar area, which had increased in numberandhadbecomepruriticoverthepastseveralmonths. Shehadahistoryofhuman immunodeficiencyvirus (HIV) with a normal CD4 count while receiving triple antiretroviral therapy, as well as a history of cervical dysplasia previously treated and followed by her gynecologist. Her familyhistorywasnegative forsimilar lesions.Onexamination, she had numerous discrete monomorphous white to skincolored keratotic papules involving her labia majora, proximal medial thighs, perineum, and gluteal cleft (Figure 1). The rest of the findings from her skin examinationwerenormal.Abiopsyspecimenwastaken(Figure2 and Figure 3). What is your diagnosis?