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Gwiti P, Jenkins M, Sutak J, Melegh Z. Two cases of rare HHV8-driven intravascular lymphoma with synchronous Kaposi sarcoma, both diagnosed at autopsy in renal transplant recipients. Autops Case Rep 2020; 10:e2020206. [PMID: 33344322 PMCID: PMC7707703 DOI: 10.4322/acr.2020.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present the first report of two rare yet remarkably similar autopsy cases of Kaposi sarcoma (KS) and intravascular human herpesvirus 8 (HHV8) positive lymphoproliferative disorder in renal transplant patients. It is well established that HHV8 infection causes Kaposi sarcoma (KS). More recently, it is recognized that HHV8 is also related to several lymphoproliferative conditions. These are poorly characterized and often difficult to diagnose. In both cases described herein, the diagnoses of multifocal hepatic KS and intravascular HHV8 positive (EBV negative) systemic diffuse large B-cell lymphoma, NOS were made at autopsy. Given the findings we describe in cases with fatal outcomes, we discuss the implications of HHV8 screening in solid allograft recipients.
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Affiliation(s)
- Paida Gwiti
- Peterborough City Hospital, Department of Cellular Pathology, Peterborough, UK
| | - Megan Jenkins
- Royal Liverpool University Hospital, Forensic Pathology Unit, Liverpool, UK
| | - Judit Sutak
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Zsombor Melegh
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
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Bender Ignacio RA, Goldman JD, Magaret AS, Selke S, Huang ML, Gantt S, Johnston C, Phipps WT, Schiffer JT, Zuckerman RA, McClelland RS, Celum C, Corey L, Wald A, Casper C. Patterns of human herpesvirus-8 oral shedding among diverse cohorts of human herpesvirus-8 seropositive persons. Infect Agent Cancer 2016; 11:7. [PMID: 26865856 PMCID: PMC4748452 DOI: 10.1186/s13027-016-0052-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/28/2015] [Indexed: 12/28/2022] Open
Abstract
Background Human herpesvirus-8 (HHV-8), the etiologic agent of Kaposi sarcoma (KS), establishes lifelong latent infection with periodic lytic replication (“shedding”) at mucosal sites, especially the oropharynx. Patterns of HHV-8 shedding are not well understood, and require elucidation to better predict risk of HHV-8 related malignancies in those infected. We sought to characterize patterns of HHV-8 oropharyngeal shedding among diverse cohorts that enrolled HHV-8 seropositive persons. Methods We quantified HHV-8 oral shedding using PCR among HHV-8 seropositive persons who collected at least 14 days of oral swabs in 22 studies on 3 continents. We excluded persons taking antivirals during sampling or any prior use of antiretrovirals in those who were HIV-infected. Results 248 participants were enrolled from the US, Peru, Cameroon, Uganda, and Kenya; 61 % were men, 58 % were HIV seropositive, and 16 % had KS. Overall, 3,123 of 10,557 samples (29.6 %) had HHV-8 detected. Quantity of virus shed was highly correlated with shedding rate, (ρ = 0.72, p < 0.0001). HHV-8 was detected in ≥1 sample in 55 % of participants with a median of 7 % of days in the US and Kenya, 0 % in Uganda and Peru, and 18 % in Cameroon. Median episode duration was three days, and episodes with high median quantity lasted longer (42 vs 3 days, p < 0.0001). In persons with multiple observations over time, 66 % of shedding rate variance was attributable to differences between individuals. Conclusions In HHV-8 infected individuals from diverse settings, oral mucosal shedding rate, quantity, and duration were correlated; individual shedding was highly variable. Studies are needed to determine factors accounting for between-person variation and the relationship of HHV-8 shedding to development of associated diseases.
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Affiliation(s)
- Rachel A Bender Ignacio
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, School of Public Health, Seattle, WA USA
| | - Jason D Goldman
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, School of Public Health, Seattle, WA USA
| | - Amalia S Magaret
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Department of Biostatistics, School of Public Health, Seattle, WA USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Stacy Selke
- Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Meei-Li Huang
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Soren Gantt
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Christine Johnston
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA
| | - Warren T Phipps
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA
| | - Joshua T Schiffer
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA
| | - Richard A Zuckerman
- Section of Infectious Disease and International Health, Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
| | - R Scott McClelland
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, School of Public Health, Seattle, WA USA.,Department of Global Health, University of Washington, Seattle, WA USA
| | - Connie Celum
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Global Health, University of Washington, Seattle, WA USA
| | - Larry Corey
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Anna Wald
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, School of Public Health, Seattle, WA USA.,Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Corey Casper
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.,Department of Epidemiology, School of Public Health, Seattle, WA USA.,Department of Global Health, University of Washington, Seattle, WA USA
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Kim KH, Lee JH, Jeong HC, Kim GW, Song SH, Jung SY, Kim GI, Kim EK. A case of human herpes virus-8 unrelated primary effusion lymphoma-like lymphoma presented as pleural effusion. Tuberc Respir Dis (Seoul) 2012; 73:336-41. [PMID: 23319997 PMCID: PMC3538188 DOI: 10.4046/trd.2012.73.6.336] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/19/2012] [Accepted: 07/03/2012] [Indexed: 01/08/2023] Open
Abstract
Primary effusion lymphoma (PEL) is a rare type of lymphoma that arises in the body cavity without detectable masses. It is associated with human herpes virus-8 (HHV-8), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV). Recently, PEL unrelated to viral infection has been reported and it has been termed HHV-8 unrelated primary effusion lymphoma-like lymphoma (HHV-8 unrelated PEL-like lymphoma). Here, we report a case of HHV-8 unrelated PEL-like lymphoma in an 80-year-old woman. Chest X-ray and computed tomography revealed left-sided pleural effusion. Pleural effusion analysis and mediastinoscopic biopsy showed atypical cells that had originated from the B cells. The cells were positive for CD20 and bcl-2, but negative for CD3, CD5, CD21, CD30, CD138, epithelial membrane antigen, and HHV-8. Serological tests for HIV and EBV were negative. Considering the patient's age, further treatments were not performed. She has shown good prognosis without chemotherapy for more than 18 months.
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Affiliation(s)
- Kyung Ho Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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Kim B, Jeon YK, Kim CW. Kaposi sarcoma herpes virus-associated hemophagocytic syndrome complicated by multicentric castleman disease and kaposi sarcoma in a HIV-negative immunocompetent patient: an autopsy case. J Korean Med Sci 2009; 24:970-4. [PMID: 19795003 PMCID: PMC2752788 DOI: 10.3346/jkms.2009.24.5.970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 07/01/2008] [Indexed: 11/20/2022] Open
Abstract
Kaposi sarcoma herpes virus (KSHV), also known as human herpesvirus-8, plays an important role in the pathogenesis of Kaposi sarcoma (KS), multicentric Castleman disease (MCD) of the plasma cell type, and primary effusion lymphoma. KSHV is rarely associated with the hemophagocytic syndrome (HPS), but when it does occur, it most occurs in immunocompromised patients. We report herein an unusual case of KSHV-associated HPS in an immunocompetent patient. A previously healthy 62-yr-old male was referred for evaluation of leukocytopenia and multiple lymphadenopathies. After a lymph node biopsy, he was diagnosed with MCD of the plasma cell type. KSHV DNA was detected in the lymph node tissue by polymerase chain reaction. Following a short-term response of the leukocytopenia to prednisolone, mental change, left side weakness, fever, thrombocytopenia, hemolytic anemia, and renal failure developed. Despite intravenous immunoglobulin therapy and plasmapheresis, he expired. The lymph nodes were infiltrated by hemophagocytic histiocytes in the sinuses. Pulmonary nodules and gastric erosions were shown to be KS. KSHV DNA was detected in the stomach, lung, and liver. This is the first case of multiple KSHV associated diseases including MCD and KS with KSHV-associated hemophagocytic syndrome in an HIV-negative, non-transplant, immunocompetent patient.
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Affiliation(s)
- Bomi Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Chul Woo Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
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