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.
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.
Barozzi
Patrizia
P
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico, Modena, Italy.
Potenza
Leonardo
L
Riva
Giovanni
G
Vallerini
Daniela
D
Quadrelli
Chiara
C
Bosco
Raffaella
R
Morselli
Monica
M
Forghieri
Fabio
F
Volzone
Francesco
F
Rossi
Giulio
G
Ferri
Clodoveo
C
Bonini
Chiara
C
Ciceri
Fabio
F
Bordignon
Claudio
C
Whitby
Denise
D
Schulz
Thomas F
TF
Torelli
Giuseppe
G
Luppi
Mario
M
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
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents