Motaparthi Kiran
Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida.
J Cutan Pathol. 2017 May;44(5):486-489. doi: 10.1111/cup.12909. Epub 2017 Feb 16.
A total of 3 cases of pseudoherpetic transient acantholytic dermatosis (Grover disease) are presented, followed by a brief review of prior reports. All 3 patients were above the age of 60 and presented with a pruritic eruption composed of papules with or without vesicles distributed on the trunk. For all 3 patients, the clinical differential diagnosis included drug eruption but did not include Grover disease; in 1 patient, the clinical impression included herpesvirus infection. Similar histologic and immunohistochemical findings were demonstrated in all 3 cases. Intraepidermal vesicles with acantholysis, multinucleation and hypereosinophilic keratinocytes mimicking necrosis raised the possibility of herpesvirus infection. However, the focality of the process at scanning magnification, absence of true cytopathic effect despite multinucleation, and identification of dyskeratosis rather than true necrosis all permitted for morphologic distinction as pseudoherpetic change. Immunohistochemistry, negative for herpes simplex virus and varicella zoster virus antigens, also distinguished pseudoherpetic change in these patients from a true herpesvirus infection. This series highlights an uncommon histologic variant of a common disorder and describes morphologic and immunohistochemical findings to facilitate its distinction from true herpesvirus infection.
本文报告了3例假疱疹性短暂棘层松解性皮病（格罗弗病），并对既往报告进行了简要回顾。所有3例患者均年龄超过60岁，表现为躯干上分布有丘疹（有或无水疱）的瘙痒性皮疹。对于所有3例患者，临床鉴别诊断包括药疹但不包括格罗弗病；在1例患者中，临床诊断印象包括疱疹病毒感染。所有3例病例均表现出相似的组织学和免疫组化结果。表皮内水疱伴棘层松解、多核化以及模仿坏死的嗜酸性角质形成细胞增多，提示疱疹病毒感染的可能性。然而，在扫描放大倍数下病变的局灶性、尽管多核化但无真正的细胞病变效应以及角化不良而非真正坏死的鉴定，均允许将其形态学区别为假疱疹性改变。免疫组化显示单纯疱疹病毒和水痘带状疱疹病毒抗原阴性，这也将这些患者的假疱疹性改变与真正的疱疹病毒感染区分开来。本系列病例突出了一种常见疾病的罕见组织学变异型，并描述了形态学和免疫组化结果，以利于将其与真正的疱疹病毒感染相区分。
