1/26. Successful treatment of Castleman's disease with HAART in two hiv-infected patients.Castleman's disease is a heterogeneous group of lymphoproliferative disorders of unknown aetiology. Recently, human herpesvirus type 8 (HHV-8) has been associated with various diseases in individuals with hiv infection, including Kaposi's sarcoma, B cell non Hodgkin's lymphomas, and Castleman's disease.In Castleman's disease it has been hypothesized that HHV-8, encoding a number of various virokines, can be responsible for clinical manifestations of the disease.Previously, two reports have described a clinical recovery from hiv-associated Castleman's disease: by administration of a monoclonal antibody neutralizing human IL-6 in one case, and in another case by treatment with highly antiretroviral therapy and anti-herpesvirus therapy, following splenectomy. We report two cases where HAART alone led to clinical recovery from Castleman's disease.In both the cases reported here, although follow-up biopsy was not performed, it is likely that the inhibition of HHV-8 replication and of virokine release, through the restoration of immunity by HAART, was the basis for the disappearance of the clinical symptoms.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
2/26. Human herpesvirus type 8 in hiv-infected patients with interstitial pneumonitis.OBJECTIVES: The new human herpesvirus type 8 (HHV-8) has been detected in all types of Kaposi's sarcomas, as well as in body-cavity lymphomas and Castleman's disease. Recently, HHV-8 has also been associated with encephalitis in hiv-positive and hiv-negative patients. Interstitial pneumonitis, combined with detection of HHV-8 in non hiv-infected patients, indicates a pathogenetic role of HHV-8 in unexplained lung diseases. We have studied two hiv-infected patients, with otherwise unexplained interstitial pneumonitis for the presence of HHV-8. methods: Lung biopsies of both patients were investigated for HHV-8 sequences. A nested PCR method was used for amplification of HHV-8 dna fragments, and the nature of the amplification products was confirmed by Southern blot hybridization. In addition, we used an in situ hybridization technique and immunohistochemical staining for detection of HHV-8 infected cells. RESULTS: Amplification of HHV-8 dna fragments was seen with template dna from lung biopsies of both cases and the appropriate positive controls, but not with negative controls. in situ hybridization and immunohistochemical staining demonstrated HHV-8 infected lymphoid cells and alveolar macrophages in both patients as well. CONCLUSIONS: HHV-8 was found in hiv-infected patients with otherwise unexplained interstitial pneumonitis, but the pathogenic role of HHV-8 in patients with interstitial pneumonia remains unclear.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
3/26. Human herpesvirus 6-meningoencephalitis in an hiv patient with progressive multifocal leukoencephalopathy.Human herpesvirus 6 (HHV6) has been reported as a rare cause of meningoencephalitis and leukoencephalitis. We present an hiv-infected patient with lesions of progressive multifocal leukoencephalopathy (PML), but also meningoencephalitis apparently due to HHV6. immunohistochemistry for HHV6 antigens and in situ polymerase chain reaction for HHV6 genome showed many positive lymphocytes and microglia in the meningeal and cortical lesions. More importantly, dead and dying neurons were conspicuous; some were undergoing neuronophagia and some displayed evidence of HHV6 infection. A pathogenic role for this almost universal, and usually commensal, virus in inflammatory brain lesions and PML is briefly discussed.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
4/26. Treatment of hiv-associated multicentric Castleman's disease with oral etoposide.Multicentric Castleman's disease (MCD) is a lymphoproliferative disorder that can be defined based upon both clinical and pathological characteristics. The clinical features of this frequently fatal disease include fever, generalized lymphadenopathy, fatigue, splenomegaly, hepatomegaly, and pancytopenia. Recently, severe forms of this disease have been diagnosed in hiv positive patients. Human herpesvirus type 8 (HHV-8) dna sequences have been detected in peripheral blood mononuclear cells (PBMCs) of patients with Kaposi's sarcoma and MCD, regardless of hiv infection status. Treatment and outcomes in hiv associated MCD are generally unfavorable. We recently treated two hiv-positive patients diagnosed with aggressive MCD with daily oral etoposide (50 mg). The first patient had relapsed on several occasions despite previous therapy with doxil, paclitaxel, and oral ganciclovir. The second patient was treatment naive. Both patients had HHV-8 detectable by polymerase chain reaction in PBMCs, widespread tumor, and B-type symptoms when therapy was initiated. In both cases remissions (documented by computerized tomography) have been durable, 1.5 and 6 months, respectively, with minimal side effects. Oral etoposide may be a safe, tolerable, and active agent in MCD.- - - - - - - - - - ranking = 0.5keywords = herpesvirus (Clic here for more details about this article) |
5/26. Primary effusion lymphoma with herpesvirus 8 dna in patients coinfected with hiv and hepatitis c virus: a report of 2 cases.The primary effusion lymphoma (PEL), commonly described in patients with AIDS, is a unique subset of diffuse large cell lymphoma in which the malignant lymphocytes proliferate exclusively in serous cavities. The cytologic, immunophenotypic, and molecular features of PEL are presented from findings of 2 patients coinfected with hiv and hepatitis c virus who presented with abdominal pain. Abdominal radiography in both patients displayed marked peritoneal effusions. Cytomorphologic examination of peritoneal fluid revealed a malignant lymphoma in both. Their immunophenotypic expression was CD30 (Ki-1) and epithelial membrane antigen. Molecular analysis demonstrated human herpesvirus 8 dna in both patients and bcl-2 oncogene rearrangement within the major breakpoint region of t(14;18) chromosome translocation in Case B only. Clinical correlation supports the current concept that PEL represents a primary hiv/AIDS-related lymphoma in effusion. Cytomorphologic examination of body cavity fluid serves as a tool for the initial diagnosis of PEL.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
6/26. Castleman disease in an hiv-infected patient with Kaposi sarcoma.Multicentric Castleman disease (MCD) is a heterogeneous lymphoproliferative disorder, characterized by systemic symptoms, generalized lymphadenopathy, hepatosplenomegaly, proteinuria, and rash. The clinical course is variable and may range from indolent to aggressive, fulminating in a rapidly fatal illness. mortality is usually from infective complications and less commonly from malignancies, such as lymphoma or Kaposi sarcoma. The association of concurrent or preceding Castleman disease with Kaposi sarcoma is well documented. Castleman disease developed in a 51-year-old patient with AIDS about 10 months after diagnosis of Kaposi sarcoma. MCD was found to be associated with human herpesvirus 8/Kaposi sarcoma-associated herpesvirus.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
7/26. Monitoring of endogenous interferon-alpha and human herpesvirus 8 in hiv-infected patients with Kaposi's sarcoma.The incidence of AIDS-associated Kaposi's sarcoma has declined since the mid-nineties due to the availability of potent antiretroviral therapy including protease inhibitors. However, Kaposi's sarcoma is still the most common neoplasia in hiv-infected patients. In the pathogenesis of the hiv-associated as well as other forms of this disease an infectious agent seems to play a role, namely the human herpesvirus 8. Even before the discovery of the hiv virus, high levels of an unusual acid-labile form of endogenous interferon alpha were found in patients with AIDS-associated KS. The administration of recombinant interferon alpha evolved as standard therapy for Kaposi's sarcoma in hiv-infected patients with a moderate immunodeficiency in addition to antiretroviral therapy. This investigation monitored the levels of HHV 8 and endogenous interferon in 4 patients with and without Kaposi's sarcoma during the course of hiv-disease. The results of our experiments lead us to two hypotheses: First of all, the pre-therapeutic level of endogenous interferon may be a predictor of the response to an interferon-alpha therapy for hiv-associated Kaposi's sarcoma. Secondly, the determination of HHV 8 dna in blood of hiv-positive patients may allow conclusions about the risk for the development of Kaposi's sarcoma. However these hypotheses should be tested by monitoring the levels of endogenous interferon and HHV 8 dna in clinical studies of a greater number of hiv-infected patients.- - - - - - - - - - ranking = 2.5keywords = herpesvirus (Clic here for more details about this article) |
8/26. Herpesvirus 8-associated penile Kaposi's sarcoma in an hiv-negative patient: first report of a solitary lesion.Kaposi's sarcoma is a neoplastic vascular lesion. Its form of onset is frequently disseminated, especially in hiv-positive patients. Its association with the infection caused by a virus of the Epstein-Barr family, human herpesvirus 8 (HHV-8), has been recently demonstrated. In this article we discuss the unusual presentation of a solitary manifestation of Kaposi's sarcoma on the penis of a 53-year-old hiv-negative patient. polymerase chain reaction analysis of the tumor tissue was positive for HHV-8 in the tumor cells but not in the reactive stroma cells surrounding the tumor. The case is interesting for its unusual site of presentation, the young age of onset, the association with HHV-8 infection, the hiv-negative serology, and the benign course of the disease.- - - - - - - - - - ranking = 0.5keywords = herpesvirus (Clic here for more details about this article) |
9/26. Nodular perianal herpes simplex with prominent plasma cell infiltration.BACKGROUND: Nodules are exceptional manifestations of herpes simplex virus (HSV) infection in immunocompromised patients. Only two cases of nodular HSV-2 infection of the perianal region have been reported previously. GOAL: The case of a 46-year-old homosexual man with AIDS presenting with painful perianal nodules resembling squamous cell carcinoma is described. STUDY DESIGN: This case report presents details of the histologic findings and treatment regimen. RESULTS: Histologic examination showed the presence of rare multinucleated giant epithelial cells and a dense inflammatory infiltrate composed mostly of plasma cells. polymerase chain reaction analysis was positive for HSV-2 and negative for HSV-1, cytomegalovirus, Epstein-Barr virus, and human herpesvirus types 6 and 7. After being treated ineffectively with oral acyclovir (4 g/d) for 15 days, the patient was treated with oral valacyclovir (6 g/d), resulting in marked improvement in 10 days and complete resolution after 2 months. CONCLUSIONS: In immunocompromised patients, HSV-2 infection may present with atypical clinical and histopathological features.- - - - - - - - - - ranking = 0.5keywords = herpesvirus (Clic here for more details about this article) |
10/26. microdissection combined with the polymerase chain reaction to identify potentiating viral co-infection in patients with hiv/AIDS with ocular infection.BACKGROUND: In the presence of several coexisting infections, superimposed tissue necrosis or tissue metaplasia, it may be difficult to recognize standard histologic morphology on hematoxylin-eosin slides. Tissue microdissection combined with the polymerase chain reaction (PCR-MD) offers the advantages of high specificity and relative speed. The objective of this study was to describe the use of PCR-MD in identifying potentiating viral co-infection in patients with hiv/AIDS with retinitis and choroiditis. methods: Eyes from two patients with hiv/AIDS with several ocular infections were studied by a variety of techniques, including standard histologic examination, immunochemistry, electron microscopy and in situ hybridization. PCR-MD was used to identify coexisting viral infections. RESULTS: Histologic examination showed cytomegalovirus retinitis in both cases. Use of PCR-MD allowed the identification of Epstein-Barr virus within a zone of fulminant varicella-zoster virus retinitis in one patient. PCR-MD confirmed the presence of human herpesvirus 8 in the second patient, who had ocular lymphoma. INTERPRETATION: PCR-MD can be used to demonstrate coexisting viral infection in ocular specimens from patients with unusually fulminant courses. Co-infections may contribute to the observed clinical course and should be considered in patients with rapid progression or unusual presentation.- - - - - - - - - - ranking = 0.5keywords = herpesvirus (Clic here for more details about this article) |
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