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Clinico-Pathological Study of 4 Cases of Pseudoherpetic Grover Disease: The Same as Vesicular Grover Disease

Capusan, Tania, M., MD*; Herrero-Moyano, María, MD*; Fraga, Javier, MD; Llamas-Velasco, Mar, MD*

The American Journal of Dermatopathology: June 2018 - Volume 40 - Issue 6 - p 445–448
doi: 10.1097/DAD.0000000000001058
Extraordinary Case Report

Introduction: Grover disease (GD) was described with 4 histopathological patterns, but later wide histopathological studies found additional ones including vesicular GD. From 2014, 2 new patterns, GD with epidermolytic hyperkeratosis and pseudoherpetic GD, have been proposed.

Objectives: The authors present 4 cases of pseudoherpetic GD and review the 6 previously published cases to better characterize this variant clinically and histopathologically.

Results: Half of the patients were men. Mean age at diagnosis was 70, 25 years old. All the patients were immunosuppressed, and 75% of them were treated with chemotherapy. Lesions were asymptomatic or itchy papules sometimes crusted and intermingled with isolated vesicles or pustules mostly in the trunk. Skin biopsies showed intraepidermal vesicles filled with plasma (50%) with floating grouped acantholytic cells. No viral inclusions were found, and immunostaining for herpes virus and varicella zoster was negative.

Discussion: Vesicular pattern in GD is described exclusively from a histopathological point of view, and it is defined as the presence of an intraepidermal vesicle filled with plasma and with dyskeratotic cells in the upper part of the vesicle. After reviewing all the described cases, pseudoherpetic GD presents the same histopathological features than vesicular GD, but authors paid attention to the presence of grouped acantholytic cells mimicking multinucleated cells of herpes infection. The authors consider that the so-called pseudoherpetic GD is a vesicular GD, where clinical suspicion of varicella raises this differential diagnosis and leads us to check viral nuclear cytopathic changes, and the authors favor the use of vesicular GD in the dermatopathologist report.

*Departments of Dermatology, and

Pathology, Hospital Universitario de la Princesa, Fundación de Investigación de La Princesa, Madrid, Spain.

Correspondence: Mar Llamas-Velasco, MD, Department of Dermatology, Hospital Universitario de la Princesa, Fundación de Investigación de La Princesa, C/Diego de León 62, CP 28006, Madrid, Spain (e-mail: mar.llamasvelasco@gmail.com).

T. M. Capusan, M. Herrero-Moyano, J. Fraga, and M. Llamas-Velasco performed the research and wrote the paper. T. M. Capusan, J. Fraga, and M. Llamas-Velasco analyzed the data. J. Fraga and T. M. Capusan contributed the cases. All the authors approved the final version of the manuscript.

The authors declare no conflicts of interest.

J. Fraga and M. Llamas-Velasco contribute equally to the work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.