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Human Herpesvirus-6 Cytopathic Inclusions: An Exceptional and Recognizable Finding on Skin Biopsy During HHV6 Reactivation After Autologous Stem-Cell Transplantation

Roux, Jennifer MD*; Battistella, Maxime MD*,†,‡; Fornecker, Luc MD†,§; LeGoff, Jérôme PharmD, PhD¶,‖; Deau, Bénédicte MD†,§; Houhou, Nadira PharmD, PhD#; Bouaziz, Jean-David MD, PhD†,**; Thieblemont, Catherine MD, PhD†,‡,‖; Janin, Anne MD, PhD*,†,‡

American Journal of Dermatopathology: August 2012 - Volume 34 - Issue 6 - p e73–e76
doi: 10.1097/DAD.0b013e31825667ed
Extraordinary Case Report

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.

*AP-HP-Hôpital Saint-Louis, Laboratoire de pathologie, Paris, France

Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de pathologie, Paris, France

INSERM, Paris, France

§AP-HP-Hôpital Saint-Louis, Haematology department, Paris, France

AP-HP-Hôpital Saint-Louis, Microbiology department, Paris, France

Université Paris Diderot, Sorbonne Paris Cité, Inserm, Paris, France

#AP-HP-Hôpital Bichat, Microbiology department, Paris, France

**AP-HP-Hôpital Saint-Louis, Dermatology department, Paris, France.

Reprints: Maxime Battistella, MD, Pathology Department, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010 Paris, France (e-mail: maxime.battistella@sls.aphp.fr).

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.