An Unusual Trigger of Grover's Disease (GD)

Abstract

Grover's disease (GD) is a rare skin condition that presents as a pruritic, erythematous papular, or papulovesicular rash. We report a unique case of GD triggered by honeybee stings. An 80-year-old Caucasian male presented with a pruritic papulovesicular rash on his trunk and arms after being stung by honeybees. He had a history of honeybee venom allergy and developed immediate erythema at the sting sites, which progressed over two days. His laboratory tests were unremarkable, including a complete blood count and comprehensive metabolic profile. Despite using oral antihistamines, emollients, and topical steroids, his rash continued to progress onto his neck, face, scalp, and back. A skin biopsy of the rash revealed suprabasilar and intraspinous acantholysis with focal corps ronds and upper dermis lymphocytic infiltrate -- the histopathologic finding of GD. He had failed first-line treatment for GD. However, after five months and significant morbidity, he was successfully treated with systemic steroids, high-potency topical steroids, emollients, and antihistamines for extensive and prolonged GD. This case report highlights honeybee venom as a possible trigger of GD and discusses a potential immune-mediated etiopathogenesis, which can be used to guide further research and management of this rare disease.

Keywords: allergens; etiopathogenesis; grover’s disease; honeybee sting; immune-mediated dermatosis; transient acantholytic dermatosis; type 2 inflammation.

Figure 1. Well-defined erythematous papulovesicular eruption on the trunk.

Figure 2. Well-defined erythematous patches and plaques on the back.

Figure 3. Hematoxylin and eosin (H&E) staining of suprabasilar acantholysis evidenced by the loss of coherence of keratinocytes (black arrow) and chronic inflammation evidenced by mononuclear inflammatory infiltrates in the dermis (white arrow). Magnification 20x.

Figure 4. Hematoxylin and eosin (H&E staining) of hyperkeratosis (yellow star), intraspinous acantholysis (black star), and corps ronds (black arrow). Magnification 20x.