title: Human Herpesvirus-6 cytopathic inclusions: an exceptional and recognizable finding on skin biopsy during HHV6 reactivation after autologous stem-cell transplantation.
abstract: Skin rash are common in immunocompromised patients, particularly after bone marrow transplantation. Human herpes virus 6 (HHV6) reactivation is often suspected, but its clinical presentation and the routine laboratory tests may be unspecific, thus leading to late diagnosis. In this case, we report specific intralymphocytic cytopathic inclusions on skin biopsy as a sign of systemic HHV6 reactivation. A 56-year-old patient presented progressive erythroderma and fever occurring after autologous hematopoietic stem-cell transplantation for mantle cell lymphoma. The skin biopsy showed a perivascular infiltrate of medium-to-large lymphocytes with irregular nuclei containing a large central basophilic inclusion surrounded by a clear halo. High levels of HHV-6 genomic in skin biopsy confirm HHV-6-induced cytopathic effect. The clinical course improved with intravenous foscavir. The specific histopathological findings encountered in this case are exceptional but recognizable, and along with HHV-6 DNA detection allow a prompt recognition of HHV6 skin rash.
authors.affiliation: AP-HP-Hôpital Saint-Louis, Laboratoire de pathologie, Paris, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Roux
authors.forename: Maxime
authors.initials: M
authors.lastname: Battistella
authors.forename: Luc
authors.initials: L
authors.lastname: Fornecker
authors.forename: Jérôme
authors.initials: J
authors.lastname: Legoff
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Deau
authors.forename: Nadira
authors.initials: N
authors.lastname: Houhou
authors.forename: Jean-David
authors.initials: JD
authors.lastname: Bouaziz
authors.forename: Catherine
authors.initials: C
authors.lastname: Thieblemont
authors.forename: Anne
authors.initials: A
authors.lastname: Janin
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003588:Cytopathogenic Effect, Viral; D005076:Exanthema / Q000473:pathology* / Q000821:virology*; D017245:Foscarnet / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D015654:Herpesvirus 6, Human / Q000302:isolation & purification* / Q000502:physiology*; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019349:Roseolovirus Infections / Q000150:complications / Q000188:drug therapy; D012867:Skin / Q000473:pathology* / Q000821:virology*; D014182:Transplantation, Autologous; D014775:Virus Activation / Q000502:physiology*
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet