---
title: "Trichodysplasia Spinulosa Polyomavirus (TSPyV) Evaluation in Skin Biopsies Using RNAscope"
id: "cdc-emerging-infectious-diseases-journal-1-evaluation-of-trichodysplasia-spinulosa-polyomavirus-in-skin-biopsies-united"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-1-evaluation-of-trichodysplasia-spinulosa-polyomavirus-in-skin-biopsies-united"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article"
published_at: "2026-09-21T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Trichodysplasia Spinulosa Polyomavirus (TSPyV) Evaluation in Skin Biopsies Using RNAscope
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-1-evaluation-of-trichodysplasia-spinulosa-polyomavirus-in-skin-biopsies-united
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article)
- **Published At:** 2026-09-21T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- This study evaluated 25 skin biopsy specimens from patients with a range of inflammatory dermatoses in California for **trichodysplasia spinulosa polyomavirus (TSPyV)** using a custom RNAscope in situ hybridization probe targeting the complete viral genome. - Biopsy indications included leukocytoclastic vasculitis, medium-vessel vasculitis, interface dermatitis, perniosis, tumid lupus, erythema nodosum, calciphylaxis, and nonspecific epidermal dermatoses; one case of trichodysplasia spinulosa served as a positive control. - Thirteen of 25 patients had received corticosteroids before biopsy; ten received steroids within 10 days of biopsy, and three had much longer intervals (108, 1,494, and 1,949 days) between steroid dose and biopsy. - A peptidylprolyl isomerase B (PPIB) RNA probe was used as a positive control to confirm RNA integrity; PPIB staining was present in all specimens. - The trichodysplasia spinulosa control showed positive TSPyV staining, validating the assay; however, **no TSPyV signal was detected in endothelial cells** of any of the 25 inflammatory skin biopsy samples. - The absence of detected endothelial TSPyV suggests the virus is **uncommon in cutaneous inflammatory conditions** sampled here, though the small cohort size could miss a low-prevalence phenomenon. - The authors contrast their negative findings with a prior report that identified TSPyV in endothelial cells of 3 patients among 252 specimens, noting that prevalence in endothelial cells may be low and context-specific. - Study procedures were performed under Stanford University IRB–approved research protocols and with patient informed consent.
## Clinical Analysis & Structured Key Points
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[EID Journal](https://wwwnc.cdc.gov/eid/) 2. [Volume 32](https://wwwnc.cdc.gov/eid/early-release) 3. [Early Release](https://wwwnc.cdc.gov/eid/early-release#issue-1346) 4. [Main Article](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article) * [Facebook](https://www.facebook.com/sharer/sharer.php?u=%2Feid%2Farticle%2F32%2F10%2F26-1264_article "Share to Facebook") * [Twitter](http://twitter.com/share?url=%2Feid%2Farticle%2F32%2F10%2F26-1264_article&text= "Share to Twitter") * [LinkedIn](https://www.linkedin.com/shareArticle?url=%2Feid%2Farticle%2F32%2F10%2F26-1264_article&title= "Share to LinkedIn") * [Syndicate](https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent//eid/article/32/10/26-1264_article "Embed this Page") [ Emerging Infectious Disease journal ISSN: 1080-6059 ](https://wwwnc.cdc.gov/eid/) _Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 10—October 2026 ##### _Research Letter_ ### Evaluation of Trichodysplasia Spinulosa Polyomavirus in Skin Biopsies, United States On This Page [Research Letter](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article) * * * [Suggested Citation](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article) Figures [Figure](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-f1) Tables [Table](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-t1) Downloads [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/10/26-1264.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article) Ivan M. Espinal, Gregory W. Charville, Lauren Lawrence, Ryanne A. Brown, Kerri E. Rieger, and Sebastian Fernandez-Pol[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#comment) Author affiliation: Stanford University, Stanford, California, USA (I.M. Espinal, G.W. Charville, R.A. Brown, K.E. Rieger, S. Fernandez-Pol); Guardant Health, Palo Alto, California, USA (L. Lawrence); Stanford Medicine, Stanford (R.A. Brown, K.E. Rieger) [Suggested citation for this article](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#suggestedcitation) ### Abstract Trichodysplasia spinulosa polyomavirus (TSPyV) has been identified in human endothelial cell tumors. We evaluated 25 clinical cases of various inflammatory dermatoses in California, USA, for TSPyV by using RNAscope in situ hybridization. We did not detect TSPyV in any of the biopsy samples, suggesting that endothelial TSPyV is uncommon in inflammatory dermatoses. Trichodysplasia spinulosa polyomavirus (TSPyV) typically causes folliculocentric cutaneous eruptions, usually on the face, although the virus has been detected in tonsillar tissue, blood, urine, cerebrospinal fluid, and respiratory specimens ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#r1 "1")–[ _4_](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#r4 "4")). Recently, TSPyV was identified within the endothelial cells of tumors from 3 separate patients by analyzing off-target next-generation sequencing reads ([_5_](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#r5 "5")). Subsequently, in situ hybridization demonstrated the localization of TSPyV to intratumoral endothelial cells. The significance of TSPyV within endothelial cells in those cases is uncertain. Of note, all 3 patients received corticosteroids immediately before tumor resection. We hypothesized that TSPyV might be found in vasculitides or other cutaneous inflammatory conditions. We evaluated skin biopsy samples from 25 patients with inflammatory dermatologic conditions. Of the 25 patients, 13 received corticosteroids before skin biopsy. Among those patients, 10 were treated with corticosteroids within 10 days of the biopsy. Three patients had longer intervals between the corticosteroid dose and the biopsy, with intervals of 108 days, 1,494 days, and 1949 days between the corticosteroid administration and the biopsy. The biopsy samples included leukocytoclastic vasculitis (n = 5), medium-vessel vasculitis (n = 1), interface dermatitis (n = 6), perniosis (n = 2), tumid lupus (n = 1), erythema nodosum (n = 4), calciphylaxis (n = 1), and nonspecific epidermal dermatoses (n =5). In addition, 1 sample of trichodysplasia spinulosa was included as a positive control. Figure ![In situ hybridization \(RNAscope\) \(5\) for trichodysplasia spinulosa polyomavirus \(TSPyV\) in tissue samples, United States. A\) Positive control tissue from a case of trichodysplasia spinulosa with staining for TSPyV. Original magnification ×200. B\) peptidylprolyl isomerase B \(PPIB\) RNA probe staining on the same control tissue. Original magnification ×400. C\) A representative case of inflammatory dermatosis with no staining for TSPyV RNA. Original magnification ×200. D\) PPIB RNA probe staining on the same tissue in \(C\). Original magnification ×200.](https://wwwnc.cdc.gov/eid/images/26-1264-F1-tn.jpg) [Figure](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-f1 "Figure"). In situ hybridization (RNAscope) ([_5_](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#r5 "5")) for trichodysplasia spinulosa polyomavirus (TSPyV) in tissue samples, United States. A) Positive control tissue from a case of trichodysplasia spinulosa with staining for... We performed in situ hybridization by using a custom RNAScope probe ([_5_](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#r5 "5")) targeting the complete TSPyV genome on tumor-associated endothelial cells within 25 dermatologic samples representing a range of inflammatory conditions. We used a peptidylprolyl isomerase B RNA probe as a positive control for RNA integrity in all specimens ([Figure](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-f1)). We did not detect TSPyV in endothelial cells in any of the 25 inflammatory skin biopsy samples. In contrast, the trichodysplasia spinulosa control had positive staining, and peptidylprolyl isomerase B staining was present in all samples ([Table](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-t1)). We found no evidence of TSPyV infection in endothelial cells in this survey of cutaneous inflammatory conditions, suggesting that TSPyV does not play a role in the cutaneous inflammatory conditions we included. Of note, our cohort is small compared with that of the previous study, which initially led to the identification of TSPyV in 3 cases from 252 specimens ([_3_](https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article#r3 "3")). Therefore, the prevalence of TSPyV infection of endothelial cells might be too low to be detected in a cohort of only 25 cases. Our findings provide evidence that endothelial TSPyV infection is not commonly detected in inflammatory skin biopsy specimens and helps refine the spectrum of tissues and clinical settings in which TSPyV should be considered. Dr. Espinal is a fourth-year anatomic and clinical pathology resident at Stanford University and an incoming gastrointestinal pathology fellow. His research interests include gastrointestinal, hematologic, and microbiologic pathology. [TopExternal Link](javascript:void\(0\)) ### Acknowledgment Evaluation and reporting of these cases were performed under research protocols approved by the institutional review board of Stanford University. The patients provided informed consent for the research. [Top](javascript:void\(0\)) ### References 1. Lawrence L, Wang A, Charville G, Liu CL, Garofalo A, Alizadeh A, et al. Identification and confirmation via in situ hybridization of Merkel cell polyomavirus in rare cases of posttransplant cutaneous T-cell lymphoma. J Cutan Pathol. 2023;50:835–44. [DOIExternal Link](https://doi.org/10.1111/cup.14486 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/37394808 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.1111%2fcup.14486&pmid=37394808 "Google Scholar") 2. Sadeghi M, Aaltonen LM, Hedman L, Chen T, Söderlund-Venermo M, Hedman K. Detection of TS polyomavirus DNA in tonsillar tissues of children and adults: evidence for site of viral latency. J Clin Virol. 2014;59:55–8. [DOIExternal Link](https://doi.org/10.1016/j.jcv.2013.11.008 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/24315796 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.1016%2fj.jcv.2013.11.008&pmid=24315796 "Google Scholar") 3. van der Meijden E, Horváth B, Nijland M, de Vries K, Rácz EK, Diercks GF, et al. Primary polyomavirus infection, not reactivation, as the cause of trichodysplasia spinulosa in immunocompromised patients. J Infect Dis. 2017;215:1080–4.[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/27578847 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?pmid=27578847 "Google Scholar") 4. Borgogna C, Albertini S, Zavattaro E, Veronese F, Peruzzi L, van der Meijden E, et al. Primary trichodysplasia spinulosa polyomavirus infection in a kidney transplant child displaying virus-infected decoy cells in the urine. J Med Virol. 2019;91:1896–900. [DOIExternal Link](https://doi.org/10.1002/jmv.25519 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/31209897 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.1002%2fjmv.25519&pmid=31209897 "Google Scholar") 5. Lawrence L, Wang A, Charville G, Toland A, Pinsky B, Natkunam Y, et al. Trichodysplasia spinulosa polyomavirus endothelial infection, California, USA. Emerg Infect Dis. 2022;28:1935–7. [DOIExternal Link](https://doi.org/10.3201/eid2809.220856 "DOI")[PubMedExternal Link](https://pubmed.ncbi.nlm.nih.gov/35997483 "PubMed")[Google ScholarExternal Link](https://scholar.google.com/scholar_lookup?doi=10.3201%2feid2809.220856&pmid=35997483 "Google Scholar") [Top](javascript:void\(0\)) ##### Figure * [ **Figure**. In situ hybridization (RNAscope) (5) for trichodysplasia spinulosa polyomavirus (TSPyV) in tissue samples, United States. A) Positive control tissue from a case of trichodysplasia spinulosa with staining for TSPyV.... ](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-f1) ##### Table * [ **Table**. Cases evaluated for trichodysplasia spinulosa polyomavirus using RNAscope in situ hybridization, United States ](https://wwwnc.cdc.gov/eid/article/32/10/26-1264-t1) [Top](javascript:void\(0\)) _Suggested citation for this article_ : Espinal IM, Charville GW, Lawrence L, Brown RA, Rieger KE, Fernandez-Pol S. Evaluation of trichodysplasia spinulosa polyomavirus in skin biopsies. Emerg Infect Dis. 2026 Oct [_date cited_]. DOI: 10.3201/eid3210.261264 Original Publication Date: September 21, 2026 [Table of Contents – Volume 32, Number 10—October 2026](https://wwwnc.cdc.gov/eid/articles/issue/32/10/table-of-contents) | EID Search Options | | --- | | ![presentation_01](https://wwwnc.cdc.gov/TemplatePackage/contrib/icons/standard/people_01.svg) [**Advanced Article Search**](https://wwwnc.cdc.gov/eid/AdvancedSearch) – Search articles by author and/or keyword. | | ![presentation_01](https://wwwnc.cdc.gov/TemplatePackage/contrib/icons/standard/map_01.svg) [**Articles by Country Search**](https://wwwnc.cdc.gov/eid/ArticleMap) – Search articles by the topic country. | | ![presentation_01](https://wwwnc.cdc.gov/TemplatePackage/contrib/icons/standard/search_01.svg) [**Article Type Search**](https://wwwnc.cdc.gov/eid/ArticleTypeSearch) – Search articles by article type and issue. | [Top](javascript:void\(0\)) Comments Please use the form below to submit correspondence to the authors or contact them at the following address: Sebastian Fernandez-Pol, Department of Pathology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H2110, Stanford, CA 94305, USA **Return Address** **Send To** Send To Authors Editors **Comments** _10000 character(s) remaining._ **Comment submitted successfully, thank you for your feedback.** **There was an unexpected error. 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