title: Complete resolution of trichodysplasia spinulosa in a pediatric renal transplant patient: Case report and literature review.
abstract: TS of immunosuppression is a rare, disfiguring dermatologic condition caused by TS-associated polyomavirus in immunosuppressed patients. It is difficult to treat, with no clearly described approach to resolve the condition completely and safely. We report a child with a renal transplant who developed TS and was treated with significant reduction in immunosuppression and transient use of cidofovir cream. The combined approach, primarily with significant long-term reduction in immunosuppression guided by monitoring BK viremia in our patient, led to complete resolution of TS without recurrence or graft rejection by 5 years after transplant. This outcome was superior to all other reports of TS in children after transplantation. Closely monitoring for BK viremia, as a surrogate marker of over-immunosuppression, can guide adjustment in immunosuppressant medication to treat polyomavirus disease without developing the complication of graft rejection in a patient at significant risk.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Coogle
authors.affiliation: Division of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Holland
authors.affiliation: Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pan
authors.affiliation: Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Van Why
mesh_terms: D001739:BK Virus / Q000276:immunology; D001706:Biopsy; D002648:Child; D006084:Graft Rejection; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D027601:Polyomavirus Infections / Q000150:complications / Q000628:therapy*; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D012867:Skin / Q000473:pathology; D012871:Skin Diseases / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000150:complications / Q000628:therapy*
chemical_list: D007166:Immunosuppressive Agents
keywords: child; immunosuppression; kidney; literature review; polyomavirus; transplantation