PMC2708076_01
Clinical image of patient immediately prior to initiation of valganciclovir therapy.
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F1
The facial papules were larger and coalesced leading to disfigurement of the nose (Figure 1).
A. Low power view (20X) demonstrating abnormally maturing anagen hair follicles with excessive inner root sheath differentiation, no normal hair papillae and hyperkeratotic, slightly dilated infundibula. B. Intermediate power view (100X) demonstrating the hyperkeratotic infundibula and the absence of mature hair sheaths.
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F2
Histopathology (Figure 2A, 2B) was consistent with the diagnosis of TOI and revealed dilated anagen hair follicles with absent hair shafts, discontinuous inner root sheath, and abnormal corneocytes filling the infundibula of the follicles, with some containing apoptotic nuclei and others containing prominent trichohyaline granules (excessive inner root sheath differentiation).
Clinical image of patient one year subsequent to initiation of valganciclovir therapy.
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F3
She was then continued on valganciclovir at a dose of 900mg once each day and has not had a resurgence of her papules over a year later (Figure 3).