Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child^☆, ^☆☆

Abstract

Some epidermal alterations in measles has been described, such as keratinocytes apoptotic, parakeratosis, giant-cell formation, intranuclear and cytoplasmic inclusions, dyskeratosis, spongiosis, and intracellular edema. The authors report for the first time in human a case of measles with the presence of multinucleated giant cells in the hair follicle and dyskeratosis in acrosyringium.

KEYWORDS
Giant cells; Hair follicle; Measles

A 9-year-old boy evolved with headache and fever. Seven days after the onset of symptoms, coughing, an episode of hemoptysis, coryza, and conjunctivitis, followed by a rash that started on the forehead with a cephalophaudal progression. He had no comorbidities or family history.

The exanthema was distributed in a cephalocaudal direction, with appearance of pruritic maculopapular lesions, some confluent plaques, more intense on the face and trunk. The physical examination revealed a hypochromic macula, with diffuse erythematosus halo, before the appearance of a rash on the oral mucosa, Koplik's sign (Fig. 1), besides erythematous papules and conjunctival hyperemia. The patient had not completed the measles vaccination scheme. A biopsy was performed in the dorsal region three days after the onset of the rash, in order to corroborate to the clinical diagnosis.

Figure 1
Koplick's sign: whitish papule surrounded by erythema.

Histopathologic findings

The skin biopsy showed hyperkeratosis, mild spongiosis, dyskeratosis, focal parakeratosis, and apoptotic keratinocytes. In follicular epithelia, was observed dyskeratosis and multinucleated giant cells (Fig. 2). The dyskeratotic alterations also compromised the acrosyringium (Fig. 3).

Figure 2
Dyskeratosis and multinucleated giant cells in follicular epithelia (Hematoxylin & eosin, ×400).

Figure 3
Dyskeratosis and mild spongiosis in acrosyringium (Hematoxylin & eosin, ×400).

Discussion

Torres, in 1952, ¹ describes in a case study the histopathologic changes in a skin biopsy of measles according to the time of biopsy. Ten hours after the eruption, the changes restricted to the epidermis, with spongiosis and karyolysis. Hyaline necrosis of epidermal cells either singly or in clumps represents the primary change in the measles eruption. In lesions biopsied after 12 h, Torres described the formation of small vesicles with necrotic keratinocytes and a few polymorphonuclear cells. At this time, he observed multinucleate epithelial giant cells in the stratum spinosum. Perivascular infiltration by mononuclear cells occurs 12 h after the eruption. In the dermis, it was described edema of the papillary layer and perivascular infiltrations in the reticular layer by large mononuclear cells some of them containing small irregular deeply stained granule, so-called Mallory-Medlar-Lipschütz cells also described.

The most common findings are parakeratosis, giant-cell formation, intranuclear and cytoplasmic inclusions, dyskeratosis, spongiosis, and intracellular edema.^1,2 It can also be described as an inflammatory infiltrate of mononuclear cells with eosinophils and capillaries with fibrin thrombi. ³ Electronic microscopy examination can show capsid particles, within the endoplasmic reticulum and secretory vesicles measuring approximately 40-60 nm in diameter, ³ and aggregates of microtubules within the nuclei and the cytoplasm of syncytial giant cells in both epidermal and oral epithelial lesions. ²

Ewing ⁴ described some findings at the hair follicles in measles, such as hydropic vacuoles in the epidermis; edema, and an increase of large round cells of dermis; edema, and various degrees of degeneration of cells of the hair follicle. The vesicle formations occur in connection with similar changes in the sebaceous glands and hair follicles, being nearly always extensively affected.

Epithelial giant cells in the hair follicles were described, in our knowledge, only by Hall et al. ⁵ in skin biopsies from Rhesus monkeys with measles rash, without documentation in humans. To the best of our knowledge, this is the first report that describes the giant cells of measles in hair follicles and dyskeratotic alterations in the acrosyringium.

• ☆
  How to cite this article: Santana MF, Ferreira LCL, Oliveira JGN, Francesconi F. Histopathological changes in epithelium of hair follicles and acrosyringium caused by measles in child. An Bras Dermatol. 2020;95:238-40.
• ☆☆
  Study conducted at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil.
• Financial support
  None declared.

References

• ¹
  Torres CM. Alterações microscópicas na erupção do Sarampo. Mem Inst Oswaldo Cruz. 1952;50:1-34.
• ²
  Suringa DWR, Bank LJ, Ackerman AB. Role of measles virus in skin lesions and Koplik's spots. N Engl J Med. 1970;283:1139-42.
• ³
  Sidhu HK, Lanoue J, Nazarian R, Mercer SE, Gordon RE, Phelps RG. Histopathology of measles: report of 2 cases with new findings. Am J Dermatopathol. 2015;37:563-6.
• ⁴
  Ewing J. The epithelial cell changes in measles. J Infect Dis. 1909;6:1-16.
• ⁵
  Hall WC, Kovatch RM, Herman PH, Fox JG. Pathology of measles in rhesus monkeys. Vet Pathol. 1971;8:307-19.

Publication Dates

• Publication in this collection
  06 July 2020
• Date of issue
  May-Jun 2020

History

• Received
  26 Sept 2018
• Accepted
  1 Feb 2019
• Published
  12 Feb 2020