1/10. Herpes incognito.Can a microscopist suspect that telltale histopathologic changes of infection by herpesvirus (varicella, zoster, or simplex) are nearby even when no diagnostic epithelial changes are present in the sections being studied? Punch-biopsy specimens from three patients are presented; in two of those cases herpesvirus infection was not even a clinical consideration. The initial histopathologic sections from these patients did not show changes of herpesvirus infection, but step sections revealed focal diagnostic changes. Atypical lymphocytes were present in each of these cases. When atypical lymphocytes are found in concert with a pattern of an inflammatory-cell infiltrate that does not conform precisely to any well-defined entity, a microscopist should consider that the findings may represent changes near infection by herpesvirus. In addition, we reviewed every case we diagnosed as herpesvirus infection over an 18-month period and found that in just over two thirds of those specimens (32 out of 45 cases), atypical lymphocytes accompanied the characteristic epithelial changes induced by herpesvirus.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
2/10. Verrucous herpes virus infection in human immunodeficiency virus patients.OBJECTIVE: Two cases of varicella-zoster virus infection that were clinically and pathologically verrucous are reported. Although this phenomenon has previously been described in the dermatology literature, it has not, to our knowledge, been described in the pathology literature. It is important that pathologists are aware of these uncommon but histologically distinctive lesions. DATA SOURCES: The patients were seen and treated at the Departments of dermatology of the University of texas health science Center at San Antonio and Brackenridge Hospital in Austin, Tex. All information was derived from the medical records and from the attending physicians. CONCLUSIONS: Verrucous lesions of herpes (varicella) zoster virus infection are rare, but they do occur in patients with the acquired immunodeficiency syndrome. Clinically, the lesions studied resembled ordinary papillomavirus-induced verrucae. Histologically, there was verrucoid epidermal hyperplasia and, unlike ordinary lesions of herpes (varicella) zoster, very little inflammation of the dermis. Diagnostic multinucleated keratinocytes with herpesvirus cytopathic changes were present within the stratum corneum.- - - - - - - - - - ranking = 0.16666666666667keywords = herpesvirus (Clic here for more details about this article) |
3/10. Varicella infection in a pediatric AIDS patient presenting as umbilicated papules.An 8-year-old girl with acquired immunodeficiency syndrome presented with fever and alteration of consciousness. She had a history of persistent cryptococcal meningitis. She developed multiple discrete umbilicated papules that resembled cutaneous cryptococcosis on the second day of admission. skin biopsy revealed an ulcer with a wedge-shaped necrosis of the dermis. The edge of the ulcer showed intracellular edema, margination of nucleoplasm and multinucleated cells, consistent with herpes infection. The diagnosis of varicella-zoster virus infection was confirmed by the identification of herpesvirus dna from the lesion and differentiation from other herpesviruses by restriction fragment length polymorphism (RFLP) method. Intravenous acyclovir was given at a dose of 500 mg/m2, three times daily for 14 days which resulted in resolution of the skin lesions within 2 weeks.- - - - - - - - - - ranking = 0.33333333333333keywords = herpesvirus (Clic here for more details about this article) |
4/10. Detection of herpesvirus-6A in a case of subacute cerebellitis and myoclonic dystonia.This is a case study of a child who developed roseola infantum first, then varicella, and was later affected by acute cerebellar syndrome, severe truncal ataxia, and myoclonic dystonia. Human herpesvirus 6 (HHV-6) A and B were detected in the cerebrospinal fluid (CSF) and peripheral blood, respectively, upon ataxia onset. The intricacy of this case suggests multifaceted conclusions ranging from the need for a multidirectional approach to neurological diseases, to confirmation of a more pronounced neurotropism of HHV-6A and a possible role of viruses in myoclonic dystonia syndrome, although this last hypothesis should be confirmed by larger studies.- - - - - - - - - - ranking = 0.83333333333333keywords = herpesvirus (Clic here for more details about this article) |
5/10. Distribution of varicella-zoster virus dna and gene products in tissues of a first-trimester varicella-infected fetus.Precise information about varicella-zoster virus (VZV) infection in first-trimester fetuses remains sketchy. After varicella infection was diagnosed in a woman, her 12-week-old fetus was aborted and was investigated, by histological examination, virus culturing, polymerase chain reaction, in situ hybridization (ISH), and immunohistochemistry (IHC), for the presence of VZV infection. Only the results of the histological examination suggested the presence of alpha -herpesvirus infection, in the gastrointestinal tract and liver; results of ISH were positive for VZV, and results of IHC staining were positive for intermediate early protein 63 (IE63) but negative for glycoprotein E (gE), in the dorsal root ganglia (DRG), meninges, gastrointestinal tract, pancreas, smooth muscle, liver, and placental trophoblast, indicating the presence of a nonproductive, latency-like VZV infection. Only the gastrointestinal tract and liver exhibited simultaneous staining for IE63 and gE, a result suggesting that active replication of VZV was present. In conclusion, widespread nonproductive VZV infection in the absence of histological clues is an early event in VZV infection in fetuses. The observed gene-expression pattern in most tissues resembles that of latent VZV infection in DRG. Latency-like infection in nonneural cell types may potentially reactivate, leading to multifocal necrosis, fibrosis, and dystrophic calcifications, as observed in advanced congenital varicella syndrome.- - - - - - - - - - ranking = 0.16666666666667keywords = herpesvirus (Clic here for more details about this article) |
6/10. Specific autologous cytotoxic T lymphocytes for chronic varicella in a liver transplanted child.Infections by herpesviruses may have severe complications in liver transplant patients. Although prophylactic varicella zoster virus vaccination is strongly recommended and widely applied, severe infection may still occur. We report the case of systemic chronic varicella, which developed in a liver allograft recipient, unresponsive to antiviral drug treatment, successfully treated by varicella zooster-specific CTL. Graft failure ensued, likely, because of massive cytolysis of infected hepatocytes. The patient, who was re-transplanted in the absence of signs of varicella zooster reactivation, is now well and disease free 3 yr after second liver transplant.- - - - - - - - - - ranking = 0.16666666666667keywords = herpesvirus (Clic here for more details about this article) |
7/10. vidarabine therapy for severe herpesvirus infections. An unusual syndrome of chronic varicella and transient immunologic deficiency.Six patients with severe herpesvirus infections were successfully treated with vidarabine. One patient had a previously undescribed syndrome of chronic cutaneous varicella infection of eight months' duration, associated with transient but complete duppression of lymphocyte response to conconavalin A. Other diagnoses were severe varicella pneumonia, progressive cytomegalovirus pneumonia associated with acute lymphocytic leukemia, herpes simplex encephalitis, severe zoster associated with stage IV lymphoma, and disseminated herpes simplex in a patient receiving high doses of steroids. All patients showed cessation of new lesions or abrupt clinical improvement between days 2 and 4 after initiation of therapy, and all were cured of their clinical infection. Dramatic improvement in all of our patients and the minimal toxicity observed make vidarabine suitable for use in severe herpesvirus infections.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
8/10. Prolonged excretion of herpesvirus varicellae in a child with acute lymphoblastic leukaemia.An eight-year-old girl with acute lymphoblastic leukaemia (ALL) in remission presented with varicella. Zoster immune globulin was not given, but treatment with acyclovir was commenced the day after presentation and continued for five days. Many of the original vesicles ulcerated and persisted for periods in excess of three months, finally leaving residual scarring. Further new vesicles appeared at 80 days and 109 days, and virus was again visualised by electron microscopy. Seroconversion was not demonstrated, although the child has in the past responded serologically to other viruses. A series of other infections afflicting the child at about the same time is documented and the possible implications are discussed.- - - - - - - - - - ranking = 0.66666666666667keywords = herpesvirus (Clic here for more details about this article) |
9/10. Distribution of human herpesvirus 6 and varicella-zoster virus in organs of a fatal case with exanthem subitum and varicella.The distribution of human herpesvirus 6 (HHV-6) and varicella-zoster virus (VZV) was examined in autopsy samples from a fatal case with both virus infections. A 9-month-old boy developed convulsive seizures followed by macular skin rashes, rapidly progressed to brain death, and died 15 days after the onset, when signs of varicella were noted. An isolation of HHV-6 from blood and evaluation of antibody activities to various viral agents including HHV-6 were performed before his death. Postmortem examinations included: (i) isolation of HHV-6 and VZV from tissues or organs; (ii) detection of both virus antigens in tissues or organs by an indirect immunofluorescent assay using monoclonal antibodies to both viruses; (iii) amplification of both viruses and human herpesvirus 7 dna sequences by a nested polymerase chain reaction assay; and (iv) endonuclease digestion of amplified products of HHV-6 dna for differentation of variants A and B. Human herpesvirus 6 dna was detected in peripheral blood mononuclear cells (PBMC) and plasma obtained at the eruptive stage but present only in PBMC 15 days after, indicating the primary infection with HHV-6, although the virus was not isolated from the same blood sample and a significant rise in the antibody titers to HHV-6 was not observed. Both virus antigens and dna were detected in various tissues or organs obtained at autopsy, but only VZV was isolated from these samples, suggesting disseminated infection with both viruses in an infant. All the amplified products of HHV-6 dna were variant B. Among the findings for the distribution of virus antigens, it was noteworthy that HHV-6 antigen was demonstrated in the endothelial cells of small vessels in the frontal lobe of the brain. There was no evidence of HHV-7 infection. These data indicate that the primary HHV-6 infection closely followed by the primary VZV infection had the potential hazard of an unexpected and apparently life-threatening event, in which disseminated infections with both viruses were noted in multiple tissues or organs including the brain.- - - - - - - - - - ranking = 1.1666666666667keywords = herpesvirus (Clic here for more details about this article) |
10/10. Chronic varicella zoster infection mimicking a basal cell carcinoma in an AIDS patient.Chronic herpesvirus infections are common in patients infected with hiv. Atypical skin lesions secondary to long-standing varicella-zoster virus (VZV) infection have been reported. We present a case of an AIDS patient with a chronic VZV infection that simulated a basal cell carcinoma. Histologic examination and immunohistochemistry confirmed the presence of the virus in the follicular epithelium. In the immunocompromised patient, biopsies should be performed on all suspicious lesions because medically-treatable infections may take on the appearance of malignancy.- - - - - - - - - - ranking = 0.16666666666667keywords = herpesvirus (Clic here for more details about this article) |
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