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Abstract: FR-PO783

"Goose Bumps" Trichodysplasia spinulosa Viremia in a Patient with Kidney Allograft

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Shaheed, Tariq A., The Permanente Medical Group, Berkeley, California, United States
  • Aulakh, Hardeep, The Permanente Medical Group, Berkeley, California, United States
  • Davila, Cynthia, The Permanente Medical Group, Berkeley, California, United States
  • Sandhu, Rana, The Permanente Medical Group, Berkeley, California, United States

Group or Team Name

  • Kaiser Family Foundation, The Permanente Medical Group, Kaiser San Francisco Hospital, Kidney Transplant Clinics.

Trichodysplasia Spinulosa (TSPyV) is a DNA virus in the polyomavirdae family first identified 1995 and genotyped 2010. This virus is ubiquitous in immune competent humans and immunosuppressed patients rarely have clinical manifestations of viremia.

Case Description

35-year-old man with h/o ESKD due to an unknown etiology s/p (DDKT) in June of 2021, HTN, Crohn's, asthma, and anaphylaxis to peanuts was seen in transplant clinic for maintenance of immune suppression on tacrolimus (Tac), mycophenolate (MMF), and prednisone. The patient developed a rash involving his gluteus, face, nose, and extremities 7 months post-transplant. (See image) He described it as “bumps with feathers growing out of them.” A shave biopsy revealed hyperkeratotic and parakeratotic debris in the hair shaft consistent with TSPyV. Treatment advised was a reduced Tac goal and reduced MMF dose as well as initiation of topical cidofovir. The patient went on a 6-month trekking trip where lesions worsened and was not available for follow up. At this time, he self-discontinued prednisone due to GI upset and stopped cidofovir after 1-2 weeks of use due to skin breakdown. He was switched from MMF to everolimus, but he stopped this due to cystic acne which he attributed to everolimus. After 13 months of adjustments the patient showed improvement of skin lesions and continues Tac with goal of (4-5) and MMF 500mg BID off prednisone Cidofovir and everolimus.


TSPyV viremia may have significant dermatologic manifestations and there are allograft threatening implications in the management which typically includes topical antivirals, clinical monitoring, and reduction of immune suppression with lower Tac goals in the 4-5 range. It is important for clinicians to counsel patients on the importance of medication adherence and follow up regarding complications of immune suppression. *Viremia not confirmed. Diagnosis made by clinical presentation and histopathological appearance.

Before and after TSPyV viremia lesions on patient's arm.