Bullous Grover's Disease in a Chinese Tibetan Adolescent: A Case Report

Abstract

Grover's disease (GD), also known as Transient acantholytic dermatosis, has no typical clinical rash features. It usually occurs in elderly white men but very rarely in China. This is a disease of acantholysis and dyskeratosis, which is usually considered to be spontaneous remission. The skin lesions of the disease are diverse, and the main symptom is severe itching. We have reported a case of GD in a 14-year-old Chinese Tibetan male whose clinical manifestations were pruritic red papule, generalized red papules, papulo vesicles and blisters ranging from millet rice to soybean size. Skin lesions change rapidly and variously. In order to confirm the diagnosis, we have done skin biopsies, immunofluorescence, dermoscopy, microscopy and other examinations. Pathological skin biopsy showed acantholysis. Intraepidermal blisters and the presence of blisters on the basal cells as well as under the stratum corneum can be observed on the same pathological section. Type IV collagen immunohistochemistry showed blisters in the epidermis. The diagnosis of GD depended on the exclusion of other diseases. After we performed whole exon sequencing (WES) on DNA from the patient's blood, pathogenic gene mutations were not found. Pustular psoriasis, Subcorneal pustular dermatosis, Herpesvirus infections, Dermatitis herpetiformis, Pemphigus vulgaris, Norwegian scabies, Darier's disease, and Hailey-Hailey disease were all excluded. We successfully treated adolescent GD with minocycline combined with methotrexate. The patient was followed up for 19 months without recurrence.

Keywords: Chinese; Grover’s disease; adolescent; case report; methotrexate; minocycline.

Figure 1

Clinical features of the patient. (A) At the admission time, the inguinal and scrotal scabs were accompanied by severe exudation. (B) After 6 days of treatment, the skin lesions basically subsided. (C-F) Red papules began to appear on both feet, and blisters gradually spread all over the body, except the head, face, and soles of the feet. (G, H) The patient was discharged with improved skin lesions, remaining milium and post-inflammatory hyperpigmentation.

Figure 2

Histopathological characteristics of the lesions. (A, C, D) Skin biopsy of right thigh showed intra-epidermal blisters which could be seen on the basal cells and under the stratum corneum; acantholytic cells, hyperplasia of stratum spinosum, basal vacuolization. A few scattered eosinophils can be seen in the shallow depth of the dermis (haematoxylin and eosin stain, original magnification x200). (B) Figure 2A enlarged to x400, the acantholytic cells could be observed in the blister. (E) Type IV collagen immunohistochemistry suggested intra-epidermal blisters (original magnification x40). (F) Original magnification x100.