title: Herpesvirus 6 variant A infection after heart transplantation with giant cell transformation in bile ductular and gastroduodenal epithelium.
abstract: Herpesvirus 6 (HHV-6) is a ubiquitous virus known to cause febrile syndromes and exanthema subitum in children. Less commonly, and particularly in organ transplant recipients, it may result in hepatitis, bone marrow suppression, interstitial pneunonitis, and meningoencephalitis. This report expands the spectrum of clinical disease associated with HHV-6 by documenting viral infection in a 44-year-old heart transplant recipient presenting with gastroduodenitis, pancreatitis, and hepatitis. On histopathologic examination, the gastric, duodenal, and bile ductular epithelium showed a multinucleate giant cell transformation similar to the cytopathic effect caused by the virus in human T-lymphocytes infected in vitro. Electron microscopy showed herpes particles with a thick tegument layer in the duodenum. Polymerase chain reaction amplified HHV-6 variant A sequences from multiple sites. Serology confirmed the presence of an acute HHV-6 infection. Thus, HHV-6 variant A can cause gastroduodenitis and pancreatitis in immunosuppressed individuals. Multinucleate giant cells and enveloped virions with a prominent tegument can be used as morphologic criteria to raise the possibility of HHV-6 infection in human biopsy tissue.
authors.affiliation: Department of Pathology, University of Pittsburgh Cancer Institute, Pennsylvania, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Randhawa
authors.forename: F J
authors.initials: FJ
authors.lastname: Jenkins
authors.forename: M A
authors.initials: MA
authors.lastname: Nalesnik
authors.forename: J
authors.initials: J
authors.lastname: Martens
authors.forename: P A
authors.initials: PA
authors.lastname: Williams
authors.forename: A
authors.initials: A
authors.lastname: Ries
authors.forename: S
authors.initials: S
authors.lastname: Pham
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000473:pathology* / Q000821:virology; D001706:Biopsy; D002472:Cell Transformation, Viral; D004382:Duodenitis / Q000473:pathology* / Q000821:virology; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology; D005756:Gastritis / Q000473:pathology* / Q000821:virology; D015726:Giant Cells / Q000473:pathology*; D016027:Heart Transplantation / Q000009:adverse effects; D006566:Herpesviridae Infections / Q000473:pathology / Q000821:virology*; D015654:Herpesvirus 6, Human / Q000648:ultrastructure*; D006801:Humans; D007413:Intestinal Mucosa / Q000648:ultrastructure / Q000821:virology; D008099:Liver / Q000473:pathology; D008297:Male; D010195:Pancreatitis / Q000209:etiology / Q000473:pathology; D016133:Polymerase Chain Reaction