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Grover's Disease after Heart Transplantation: A Case Report.

Ippoliti G, Paulli M, Lucioni M, D'Armini AM, Lauriola M, Mahrous Haleem Saaleb R - Case Rep Transplant (2012)

Bottom Line: Grover's disease is a transient acantholytic dermatosis of unknown cause, manifesting clinically as a papular skin eruption that is usually located on the anterior chest and abdomen.Histologically characterized by an acantholytic pattern, it has been associated with numerous disorders, including hematologic malignancies, chronic renal failure, and HIV infection, as well as with chemotherapy and bone marrow and/or kidney transplant.Evaluation of followup and treatment is often complicated by spontaneous remission and the occasionally fluctuant course of the disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiac Surgery, IRCCS San Matteo Hospital Foundation, University of Pavia School of Medicine, 27100 Pavia, Italy ; U.O. Medicina Interna, Policlinico di Monza, Monza, Italy.

ABSTRACT
Grover's disease is a transient acantholytic dermatosis of unknown cause, manifesting clinically as a papular skin eruption that is usually located on the anterior chest and abdomen. Histologically characterized by an acantholytic pattern, it has been associated with numerous disorders, including hematologic malignancies, chronic renal failure, and HIV infection, as well as with chemotherapy and bone marrow and/or kidney transplant. Evaluation of followup and treatment is often complicated by spontaneous remission and the occasionally fluctuant course of the disease. Here we report the case of a patient with sudden onset of Grover's disease after heart transplantation. To the best of our knowledge, this is the first observation of Grover's disease as diagnosed after heart transplantation.

No MeSH data available.


Related in: MedlinePlus

Epidermis showed hypergranulosis and suprabasal clefts containing acantholytic dyskeratotic keratinocytes (H&E 200x).
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Related In: Results  -  Collection


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fig3: Epidermis showed hypergranulosis and suprabasal clefts containing acantholytic dyskeratotic keratinocytes (H&E 200x).

Mentions: The patient had undergone heart transplantation (HTx) 22 years previously on account of dilatated cardiomyopathy. After HTx, immunosuppression consisted of RATG (Rabbit antithymocyte globulin) for three days, cyclosporine A (CSA), azathioprine, and steroids. No acute rejection episodes were observed during followup. Eleven years after HTx, the patient developed a posttransplant lymphoproliferative disorder (PTLD) which, at biopsy, proved to be an EBV-negative B-cell diffuse large cell lymphoma (B-DLCL). Azathioprine was eliminated and CSA doses were reduced by 50%. Chemotherapy with CHOP regimen (cyclophosphamide, vincristine, adriblastine, and prednisone) was started and continued for a total of six treatment cycles. Complete remission was achieved and confirmed by continuous followup. On admission to our center, the patient was on low-doses of CSA (trough levels: 70 μg/L) and prednisone (2.5 mg/d). Laboratory data revealed creatinine = 2.67 mg/dL. Autoimmunity, cryoglobulins, and PCR for EBV, CMV, HHV-8, HCV, and Parvovirus B19 were negative. No relapse of NHL was observed. Punch biopsies from two different cutaneous lesions were performed and histological examination of both skin samples documented an acantholytic dermatosis, which exhibited a Darier disease-like pattern. Focal hypergranulosis and suprabasal clefts containing acantholytic and dyskeratotic keratinocytes were observed in the epidermis. A loose perivascular lymphoid infiltrate, which included a few eosinophils and neutrophils, was found in the superficial dermis (Figures 2 and 3). Direct immunofluorescence was negative. During hospitalization, skin lesions began to improve. The patient was discharged to the outpatient-clinic to continue follow up. Skin lesions disappeared in two months. Clinicopathologic features were consistent with the diagnosis of transient acantholytic dermatosis (GD).


Grover's Disease after Heart Transplantation: A Case Report.

Ippoliti G, Paulli M, Lucioni M, D'Armini AM, Lauriola M, Mahrous Haleem Saaleb R - Case Rep Transplant (2012)

Epidermis showed hypergranulosis and suprabasal clefts containing acantholytic dyskeratotic keratinocytes (H&E 200x).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539346&req=5

fig3: Epidermis showed hypergranulosis and suprabasal clefts containing acantholytic dyskeratotic keratinocytes (H&E 200x).
Mentions: The patient had undergone heart transplantation (HTx) 22 years previously on account of dilatated cardiomyopathy. After HTx, immunosuppression consisted of RATG (Rabbit antithymocyte globulin) for three days, cyclosporine A (CSA), azathioprine, and steroids. No acute rejection episodes were observed during followup. Eleven years after HTx, the patient developed a posttransplant lymphoproliferative disorder (PTLD) which, at biopsy, proved to be an EBV-negative B-cell diffuse large cell lymphoma (B-DLCL). Azathioprine was eliminated and CSA doses were reduced by 50%. Chemotherapy with CHOP regimen (cyclophosphamide, vincristine, adriblastine, and prednisone) was started and continued for a total of six treatment cycles. Complete remission was achieved and confirmed by continuous followup. On admission to our center, the patient was on low-doses of CSA (trough levels: 70 μg/L) and prednisone (2.5 mg/d). Laboratory data revealed creatinine = 2.67 mg/dL. Autoimmunity, cryoglobulins, and PCR for EBV, CMV, HHV-8, HCV, and Parvovirus B19 were negative. No relapse of NHL was observed. Punch biopsies from two different cutaneous lesions were performed and histological examination of both skin samples documented an acantholytic dermatosis, which exhibited a Darier disease-like pattern. Focal hypergranulosis and suprabasal clefts containing acantholytic and dyskeratotic keratinocytes were observed in the epidermis. A loose perivascular lymphoid infiltrate, which included a few eosinophils and neutrophils, was found in the superficial dermis (Figures 2 and 3). Direct immunofluorescence was negative. During hospitalization, skin lesions began to improve. The patient was discharged to the outpatient-clinic to continue follow up. Skin lesions disappeared in two months. Clinicopathologic features were consistent with the diagnosis of transient acantholytic dermatosis (GD).

Bottom Line: Grover's disease is a transient acantholytic dermatosis of unknown cause, manifesting clinically as a papular skin eruption that is usually located on the anterior chest and abdomen.Histologically characterized by an acantholytic pattern, it has been associated with numerous disorders, including hematologic malignancies, chronic renal failure, and HIV infection, as well as with chemotherapy and bone marrow and/or kidney transplant.Evaluation of followup and treatment is often complicated by spontaneous remission and the occasionally fluctuant course of the disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiac Surgery, IRCCS San Matteo Hospital Foundation, University of Pavia School of Medicine, 27100 Pavia, Italy ; U.O. Medicina Interna, Policlinico di Monza, Monza, Italy.

ABSTRACT
Grover's disease is a transient acantholytic dermatosis of unknown cause, manifesting clinically as a papular skin eruption that is usually located on the anterior chest and abdomen. Histologically characterized by an acantholytic pattern, it has been associated with numerous disorders, including hematologic malignancies, chronic renal failure, and HIV infection, as well as with chemotherapy and bone marrow and/or kidney transplant. Evaluation of followup and treatment is often complicated by spontaneous remission and the occasionally fluctuant course of the disease. Here we report the case of a patient with sudden onset of Grover's disease after heart transplantation. To the best of our knowledge, this is the first observation of Grover's disease as diagnosed after heart transplantation.

No MeSH data available.


Related in: MedlinePlus