title: Fatal Outcome of Multiple Clinical Presentations of Human Herpesvirus 8-related Disease After Solid Organ Transplantation.
abstract: Kaposi sarcoma is the most common human herpesvirus 8 (HHV-8)-related disease described after solid organ transplantation. Multicentric Castleman disease and hemophagocytic syndrome are other potential HHV-8-induced entities but are less frequently reported. We describe the case of a liver transplant recipient who presented with an acute febrile illness 1 year after transplantation with a rapidly fatal outcome. Autopsy revealed 3 distinct HHV-8-related entities: Kaposi sarcoma, HHV-8-associated multicentric Castleman disease with microlymphomas and a severe hemophagocytic syndrome. Retrospective serologic tests suggested that HHV-8 was likely transmitted by the seropositive donor at the time of transplantation. To our knowledge, this is the first case of copresentation of 3 clinical presentations of HHV-8-mediated human disease in the post-transplant setting. Considering the absence of systematic screening of organ donors/recipients for HHV-8 infection, HHV-8-related illness should be suspected in transplant recipients who present with acute febrile illness, systemic symptoms, lymphadenopathies, and/or multiorgan failure to rapidly document the diagnosis and provide timely an adequate treatment.
authors.affiliation: 1 Institute of Pathology, University Hospital (CHUV), Lausanne, Switzerland. 2 Institute of Microbiology, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 3 Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland. 4 Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vijgen
authors.forename: Caroline
authors.initials: C
authors.lastname: Wyss
authors.forename: Pascal
authors.initials: P
authors.lastname: Meylan
authors.forename: Bettina
authors.initials: B
authors.lastname: Bisig
authors.forename: Igor
authors.initials: I
authors.lastname: Letovanec
authors.forename: Oriol
authors.initials: O
authors.lastname: Manuel
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.forename: Laurence
authors.initials: L
authors.lastname: de Leval
mesh_terms: D000368:Aged; D001344:Autopsy; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005871:Castleman Disease / Q000175:diagnosis / Q000821:virology*; D002423:Cause of Death; D017809:Fatal Outcome; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000635:transmission / Q000821:virology*; D019288:Herpesvirus 8, Human / Q000472:pathogenicity*; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000821:virology*; D012698:Serologic Tests; D013997:Time Factors; D016896:Treatment Outcome