Acta Dermato-Venereologica 99-13CompleteContent | Page 20

SHORT COMMUNICATION Neutrophil-rich Variant of Persistent Bullous Grover’s Disease Sayaka TOGO 1 , Kentaro OZAWA 1 *, Asami FUJII 1 , Tsukasa TANII 2 , Daisuke TSURUTA 3 , Norito ISHII 4 , Takashi HASHIMOTO 4 , Taketsugu TADOKORO 1 and Taiki ISEI 1 Department of Dermatology, Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka 540-0006, 2 Tanii Dermatology Clinic, 3 Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, and 4 Department of Dermatology, Kurume University School of Medicine, Kurume, Japan. *E-mail address: [email protected] 1 Accepted Sep 12, 2019; E-published Sep 12, 2019 The aetiology of Grover’s disease, which was initially described by Grover in 1970 as transient acantholytic dermatosis, is unknown. Although the disease typically resolves within 6–12 months, it can persist for several years. We report here an atypical and unique case of per- sistent Grover’s disease that presented with predominant bullous skin lesions with neutrophil-rich infiltration. CASE REPORT A 77-year-old Japanese woman was referred to our de- partment in June 2012 because of multiple pruritic bullae and vesicles surrounded by minor ery­thema on the trunk and limbs (Fig. 1a), which had initially developed 2 months earlier. She had been treated with topical corticos- teroids, which resulted in temporary and moderate relief. (a) 1282 Laboratory blood test results revealed an unremarkable haematological profile. Enzyme-linked immunoassay (ELISA) tests for antibodies to desmoglein 1, desmo­ glein 3 and BP180 were all negative. Moreover, bacterial culture of the blister content was negative. Initial biopsy of the vesicle on the chest revealed an intraepidermal blister containing acantholytic cells and substantial neutrophil accumulation (Fig. 1b). Neutrophilic infiltra- tion was also seen in the papillary dermis. Acantholytic suprabasal clefts with dyskeratotic cells were noted at different sites on the same specimen (Fig. 1c). Direct im- munofluorescence microscopy did not reveal deposition of immunoglobulin (Ig)G, IgM, IgA, C3 or fibrinogen. Based on these findings, the patient was diagnosed with Grover’s disease. She was administered minocy- cline (200 mg/day), which resulted in rapid regression of (b) (d) Fig. 1. Clinical, histopathological and direct immunofluorescence microscopic findings in the present patient. (a) Clinical features at first visit. (b) Histopathological findings with massive neutrophilic infiltrate in the epidermis (haematoxylin and eosin (HE) ×100; ×400 inset). (c) Histopathological evaluation showed suprabasal acantholytic cleft and dyskeratosis (HE ×100). (d) Results for C3 deposition in the second biopsy. doi: 10.2340/00015555-3316 Acta Derm Venereol 2019; 99: 1282–1283 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.