PMC5028978_01
PMC5028978_02
Histopathologic and immunophenotypic studies of ipilimumab-induced Grover's disease. a-c Scanning magnification of skin with acantholytic dyskeratosis (a, H&E, 20x). Higher magnification reveals skin with suprabasal acantholysis and overlying dyskeratosis; (b, H&E, 100x) and (c, H&E, 40x). Immunohistochemical studies demonstrate a predominance of CD3+ T-cells (d, anti-CD3, 100x) comprised of a predominance of CD4+ T-cells (e, anti-CD4, 100x) over CD8+ T-cells (f, anti-CD8, 100x). Additional immunohistochemical studies demonstrate strong expression of PD-L1 by the inflammatory cells (g, anti-PD-L1, 100x; inset, 400x). Scattered cells express PD-1 (h, anti-PD-1, 100x; inset 400x). There is scattered nuclear expression of FoxP3 (i, anti-FoxP3, 100x; inset 400x) and T-beta (j, anti-T-Bet, 100x; inset, 400x) but strong diffuse nuclear expression of Gata-3 by the majority of the inflammatory cells as well as the overlying keratinocytes (k, anti-Gata-3, 100x; inset: 400x). Antibodies for RORgT are essentially negative in the infiltrate. There is strong background staining in the skin tissue (l, anti-RORgT, 100x; inset: 400x)
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Fig1
A skin biopsy was performed and histopathologic examination revealed suprabasal acantholysis with associated overlying dyskeratosis, consistent with Grover's disease (Fig. 1a-c). Immunohistochemical (IHC) studies demonstrated a predominance of CD3+ T-cells with a predominance of CD4+ over CD8+ T-cells (Fig. 1d-f).
Chronologic timeline of patient's clinical course
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Fig2
A treatment course timeline is included as Fig. 2.