title: Cytology of pleural effusion associated with disseminated infection caused by varicella-zoster virus in an immunocompromised patient. A case report.
abstract: BACKGROUND
  Pleural effusion caused by varicella-zoster virus (VZV) is rare. We report a case of a woman with acute lymphocytic leukemia (ALL) who developed a pleural effusion caused by VZV infection.
  
  
  METHODS
  A 55-year-old woman with ALL treated with consolidation therapy developed skin vesicles and a pleural effusion. Pleural fluid smears contained numerous mesothelial cells, which had ground-glass nuclei or eosinophilic nuclear inclusions. Some multinucleated giant cells were also seen. Electron microscopic examination revealed intranuclear virus particles, about 150 nm in diameter, in some mesothelial cells. Tissue samples from the skin, lungs, pleura, liver, pancreas, kidneys and gastrointestinal tract, obtained at autopsy, contained many virus-infected cells. They were positive for VZV glyco-protein 1 by immunohistochemistry.
  
  
  CONCLUSIONS
  VZV infection should be considered in the differential diagnosis of an unexplained exudative pleural effusion, especially in immunocompromised hosts.
authors.affiliation: Department of Surgical Pathology, Fukui Medical University Hospital, Departments of Pathology and Clinical Laboratory Medicine, Fukui Medical University, Matsuoka, Fukui, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Imamura
authors.forename: Hideki
authors.initials: H
authors.lastname: Maegawa
authors.forename: Haruyoshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Hironobu
authors.initials: H
authors.lastname: Naiki
authors.forename: Masaru
authors.initials: M
authors.lastname: Fukuda
mesh_terms: D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D004848:Epithelium / Q000648:ultrastructure / Q000821:virology; D005260:Female; D006562:Herpes Zoster / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification* / Q000378:metabolism / Q000648:ultrastructure; D006801:Humans; D016867:Immunocompromised Host; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology* / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology* / Q000473:pathology / Q000821:virology; D014759:Viral Envelope Proteins / Q000378:metabolism
chemical_list: D014759:Viral Envelope Proteins; C056913:glycoprotein E, varicella-zoster virus