An Eruption of Numerous Spiny Papules in a Pediatric Transplant Patient

An 8-year-old African American female, who had undergone a renal transplant, presented with numerous tiny, white folliculocentric papules and spicules on her face, along with alopecia of the eyebrows and eyelashes. The patient was on a stable immunosuppressive regimen and had a history of antibody-mediated rejection treated with methylprednisolone and rituximab. A biopsy revealed abnormal eosinophilic inclusions in the hair follicle's inner root sheath, suggesting a diagnosis of virus-associated trichodysplasia spinulosa, linked to the trichodysplasia spinulosa–associated polyomavirus. After appropriate treatment, the patient showed improvement in the skin condition and regrowth of eyelashes and eyebrows. The safest next step recommended was a reduction in the immunosuppressive regimen.