Angioimmunoblastic lymphadenopathy with disseminated human herpesvirus 6 infection in a patient with acute myeloblastic leukemia.
A 47-year-old man with acute myeloblastic leukemia (AML) developed angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) 4 months after induction chemotherapy for AML. During a leukopenic period, the patient suffered from pericarditis with massive pericardial effusion in which human herpesvirus 6 (HHV-6) DNA was detected. Although complete remission of AML was achieved, fever persisted and atypical skin rash followed by generalized lymphadenopathy along with polyclonal hypergammaglobulinemia appeared. A diagnosis of AILD was made on a biopsy specimen of the inguinal lymph node. The patient died of fulminant hepatitis and the autopsy showed lymphomatous infiltrates involving the liver, bone marrow, lungs, spleen, kidneys and heart. HHV-6 DNA sequences were identified in the biopsy specimen of the lymph node and in the involved organ tissues. HHV-6 in this patient was variant B. It is known that HHV-6 can be reactivated in immunocompromised patients and causes severe complications. This unusual clinical course suggests that the immunosuppression associated with AML and the additional iatrogenic immunosuppression following cytopenia-inducing chemotherapy predisposed the patient to reactivated HHV-6 infection. The sequential detection of this virus before and after manifestation of AILD may support the evidence that HHV-6 infection could directly or indirectly trigger AILD. This is the first time that such a sequence of events has been reported to our knowledge. The possibility of HHV-6 infection should be considered when unexplained fever and generalized lymphadenopathy are seen in patients with leukemia, and administration of antiviral agents should be considered for the diagnostic evaluation.
Daibata
M
M
Department of Medicine, Kochi Medical School, Japan.
Ido
E
E
Murakami
K
K
Kuzume
T
T
Kubonishi
I
I
Taguchi
H
H
Miyoshi
I
I
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001344:Autopsy; D003561:Cytarabine / Q000008:administration & dosage; D004279:DNA, Viral / Q000032:analysis; D017809:Fatal Outcome; D005334:Fever; D006566:Herpesviridae Infections / Q000150:complications* / Q000473:pathology; D015654:Herpesvirus 6, Human / Q000302:isolation & purification; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications; D015255:Idarubicin / Q000008:administration & dosage; D007119:Immunoblastic Lymphadenopathy / Q000150:complications* / Q000276:immunology / Q000473:pathology; D016130:Immunophenotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000150:complications; D016133:Polymerase Chain Reaction / Q000379:methods; D012074:Remission Induction; D014412:Tumor Virus Infections / Q000150:complications* / Q000473:pathology
D004279:DNA, Viral; D003561:Cytarabine; D015255:Idarubicin