Case Number : Case 2677 - 09 October 2020 Posted By: Dr. Richard Carr

Marked orthohyperkatosis of almost acral proportions.  The underlying epidermis is irregularly acanthotic.  There are very pretty eosinophilic cytoplasmic inclusions reminiscent of a pox virus infection but without the expected underlying inflammation.  I think this must be HPV-induced wart disease. Eosinophilic inclusions like this are more typical of HPV-1 lesions which would be most unusual at this site.  Perhaps it is another of the rarer HPV types.  Is the patient immunosuppressed?

EDV?

?Myrmecia

Agree ? Myrmecia warts.

Classically a myrmecium wart is an endophytic plantar wart, so-called because of its structural resemblance to an ant hill.  I don't think we can accurately use that description for this clinical situation.

A curious and pretty case indeed. I'd guess it's HPV1 (myrmecia) though and would have reported it as such. The skin is markedly lichenified (hairy palm sign) presumably due to constant rubbing.

Without being able to sub-type the HPV we won't know which type was responsible here.  What I would say is that my concept of HPV-1 lesions was that they were usually solitary plantar lesions, and more immunogenic than the other common types.  This is why they induced a painful inflammatory response and generally had a much shorter clinical course than other types of viral warts.  I don't see much inflammation associated with this lesion.

Thanks Richard

Nice!