title: Changes in T-cell responses against human herpesvirus-8 correlate with the disease course of iatrogenic Kaposi's sarcoma in a patient with undifferentiated arthritis.
abstract: OBJECTIVE
  To describe the first in-depth analysis of both the T-cell responses against human herpesvirus-8 (HHV-8) and the HHV-8 viral load in 1 patient who developed iatrogenic HHV-8-associated-Kaposi's sarcoma (KS) following immunosuppressive treatment for undifferentiated arthritis and to review the literature on iatrogenic KS (IKS).
  
  
  METHODS
  T-cell responses against HHV-8 lytic and latent antigens were analyzed by ex vivo enzyme-linked immunospot (Elispot) and HHV-8 viral load was assessed by quantitative polymerase chain reaction, in sequential peripheral blood samples from a 55-year-old woman who developed skin/mucosal and visceral KS, while receiving treatment with cyclosporine, methotrexate, and methylprednisolone for undifferentiated arthritis.
  
  
  RESULTS
  KS may result from HHV-8 infection in patients undergoing immunosuppressive treatment for rheumatic diseases and this is the first case of IKS occurring in undifferentiated arthritis. A role for immune surveillance in the pathogenesis of IKS is supported by the observation of disease regression following discontinuation of immunosuppressive therapy. In a 4-year follow-up, we showed that variations of the virus-specific immune responses but not of the viral load correlated well with the disease course, characterized by 2 remission and subsequent relapse phases, following changes of immunosuppressive therapy.
  
  
  CONCLUSIONS
  We have provided evidence of a clear-cut correlation between changes in immunologic markers of HHV-8 infection and the disease course of this viral associated tumor, concomitant with variations of immunosuppressive treatment. Thus, ex vivo enzyme-linked immunospot for HHV-8-specific T-cell responses represents a new tool for the clinical management of rheumatic patients with IKS.
authors.affiliation: Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Modena, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Barozzi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Potenza
authors.forename: Giovanni
authors.initials: G
authors.lastname: Riva
authors.forename: Daniela
authors.initials: D
authors.lastname: Vallerini
authors.forename: Chiara
authors.initials: C
authors.lastname: Quadrelli
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bosco
authors.forename: Monica
authors.initials: M
authors.lastname: Morselli
authors.forename: Fabio
authors.initials: F
authors.lastname: Forghieri
authors.forename: Francesco
authors.initials: F
authors.lastname: Volzone
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonini
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.forename: Claudio
authors.initials: C
authors.lastname: Bordignon
authors.forename: Denise
authors.initials: D
authors.lastname: Whitby
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Schulz
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Torelli
authors.forename: Mario
authors.initials: M
authors.lastname: Luppi
mesh_terms: D000914:Antibodies, Viral / Q000097:blood*; D001168:Arthritis / Q000150:complications* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019288:Herpesvirus 8, Human / Q000276:immunology*; D006801:Humans; D007049:Iatrogenic Disease; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000276:immunology; D012514:Sarcoma, Kaposi / Q000209:etiology / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology*; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral; D007166:Immunosuppressive Agents