Acute skin graft-versus-host disease with molecular features mimicking herpes simplex virus-associated erythema multiforme: report of three cases.
BACKGROUND
Acute skin erythematous lesions that follow allogeneic hematopoietic stem cell transplantation (HSCT) and are histologically diagnosed as graft-versus-host disease (GVHD) are often associated with reactivation of latent herpes simplex virus (HSV).


OBJECTIVE
To further examine the relationship between reactivated HSV and GVHD development.


METHODS
We present 3 patients with acute skin GVHD after allogeneic HSCT who were studied prospectively for expression of the HSV antigen Pol, which is involved in HSV-associated erythema multiforme.


RESULTS
Pol was expressed in the GVHD lesions but not the pre-HSCT normal skin or peripheral blood mononuclear cells. Lesion severity correlated with the Pol levels but not the histopathologically defined GVHD grade. Lesion development was accompanied by increased numbers of Pol+ circulating/skin-infiltrating CD34+ stem cells and CD1a+ and other dermal dendritic cells.


CONCLUSIONS
Subclinical HSV infection of circulating CD34+ cells can contribute to some post-HSCT skin lesions histologically diagnosed as GVHD, with potential preventive and therapeutic implications.
Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Md., USA.
Ranjit
R
Joseph
Marianna
M
Shvartsbeyn
Canan
C
Günay
Görgün
G
Akpek
Laure
L
Aurelian
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004892:Erythema Multiforme / Q000821:virology*; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018139:Simplexvirus; D016896:Treatment Outcome
D000998:Antiviral Agents