Cytology of pleural effusion associated with disseminated infection caused by varicella-zoster virus in an immunocompromised patient. A case report.
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.
Mori
Masaki
M
Department of Surgical Pathology, Fukui Medical University Hospital, Departments of Pathology and Clinical Laboratory Medicine, Fukui Medical University, Matsuoka, Fukui, Japan.
Imamura
Yoshiaki
Y
Maegawa
Hideki
H
Yoshida
Haruyoshi
H
Naiki
Hironobu
H
Fukuda
Masaru
M
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
D014759:Viral Envelope Proteins; C056913:glycoprotein E, varicella-zoster virus