Bright, Eosinophilic Intracytoplasmic Inclusion Bodies: A Rare Presentation of Acquired Epidermodysplasia Verruciformis with Widespread Human Papillomavirus Infection in a Transplant Recipient

This case study describes a rare presentation of acquired epidermodysplasia verruciformis (EV) in a 46-year-old Afro-Caribbean woman who had undergone a pancreas-kidney transplant. The patient exhibited widespread, pigmented, keratinous papules, particularly on the face, which initially suggested trichodysplasia spinulosa (TS). However, punch biopsies revealed histological features consistent with EV, including unique eosinophilic intracytoplasmic inclusion bodies indicative of HPV-49 infection. This is notable as EV is typically associated with other HPV serotypes, making this the second reported case of EV linked to HPV-49. The findings highlight the importance of considering EV in post-transplant patients presenting with similar dermatological symptoms.