Abstract:

Transient acantholytic dermatosis (TAD), also known as Grover disease, was described in 1970 by Ralph Weir Grover. Soon after, Chalet and Ackerman joined Grover to publish histopathologic diagnostic criteria for TAD specifying inclusion of one or more of four histologic patterns: spongiotic, pemphigus vulgaris-like, benign familial pemphigus-like (Hailey-Hailey-like), and keratosis follicularis-like (Darier-like). Numerous clinicohistologic patterns have since been described, including dysmaturative, lichenoid, vesicular, lentiginous, porokeratotic, and pseudo-herpetic. We present two patient cases with three different patterns: pemphigus vulgaris-like, spongiotic, and porokeratotic. In case one, a 78-year-old male hospitalized for abdominal aortic aneurysm repair developed a pruritic papular and vesicular rash on the back and buttocks. Punch biopsies and direct immunofluorescence (DIF) were performed and revealed suprabasilar acantholysis with corp grans and an underlying superficial, predominantly eosinophilic infiltrate with eosinophil exocytosis. Although clinical vesicle formation and histologic suprabasilar acantholysis was suggestive of pemphigus vulgaris, peri-lesional DIF was negative. In case two, a 68-year-old male presented to an outside dermatology clinic for a pruritic rash. Two punch biopsies were obtained from the upper back and submitted with the differential diagnosis of basal cell carcinoma, Grover disease, and eczema. One biopsy showed a spongiotic epidermis with multiple foci of suprabasilar acantholysis. The other showed tiers of parakeratosis with underlying acantholysis and dyskeratosis. Previous cases of porokeratotic TAD that have been reported tend to exhibit spongiosis. We present two patient cases of three infrequently reported variants of TAD to highlight the importance of clinical-pathologic correlation and maintaining high pathologic suspicion given the diverse clinical and histological variations.

Financial Disclosure:
No current or relevant financial relationships exist.

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Tyler Coolman, DO, MPH