Schwieger-Briel Agnes, Balma-Mena Alexandra, Ngan BoYee, Dipchand Anne, Pope Elena
Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Dermatol. 2010 Sep-Oct;27(5):509-13. doi: 10.1111/j.1525-1470.2010.01278.x. Epub 2010 Aug 26.
Immunosuppression is necessary in a large number of conditions to modify immune responses and control disease severity. It is a vital part of treatment regimes following organ and bone marrow transplants. However, the use of immunosuppressive drugs has been shown to cause infections with common and unusual pathogens. We present the case of a 5-year-old female heart transplant recipient. Nine months after the transplant, she developed a tender acneiform eruption on her face consisting of numerous small yellowish to pink papules and pustules. Many of the lesions had a central, firm, small spinulous excrescence or a central dell. Histopathology demonstrated abnormal maturation of the hair follicles, nucleated eosinophilic cells with trichohyalin granules. The clinical presentation and histological features were in keeping with trichodysplasia spinulosa, a rare complication in immunosuppressed subjects. Treatment trials included reduction of immunosuppression combined with topical and oral retinoids, topical acyclovir, and oral valganciclovir with limited success.
在许多情况下，免疫抑制对于调节免疫反应和控制疾病严重程度是必要的。它是器官和骨髓移植后治疗方案的重要组成部分。然而，使用免疫抑制药物已被证明会导致常见和不常见病原体的感染。我们报告一例5岁女性心脏移植受者的病例。移植后9个月，她脸上出现了一种触痛性痤疮样皮疹，由许多小黄至粉红色丘疹和脓疱组成。许多皮损中央有一个坚实的、小的棘状赘生物或中央凹陷。组织病理学显示毛囊成熟异常，有含毛透明颗粒的有核嗜酸性细胞。临床表现和组织学特征符合棘状毛发发育异常，这是免疫抑制患者的一种罕见并发症。治疗试验包括减少免疫抑制并联合外用和口服维甲酸、外用阿昔洛韦和口服缬更昔洛韦，但效果有限。
