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Herpesvirus 6 Variant A Infection After Heart Transplantation with Giant Cell Transformation in Bile Ductular and Gastroduodenal Epithelium

Randhawa, Parmjeet S. M.D.; Jenkins, Frank J. Ph.D.; Nalesnik, Michael A. M.D.; Martens, Jeffrey M.D.; Williams, Penny A. M.D.; Ries, Ardith B.S.; Pham, Si M.D.; Demetris, Anthony J. M.D.

The American Journal of Surgical Pathology: July 1997 - Volume 21 - Issue 7 - p 847-853
Case Reports

Herpesvirus 6 (HHV-6) is a ubiquitous virus known to cause febrile syndromes and exanthema subitum in children. Less commonly, and particularly in organ transplant recipients, it may result in hepatitis, bone marrow suppression, interstitial pneunonitis, and meningoencephalitis. This report expands the spectrum of clinical disease associated with HHV-6 by documenting viral infection in a 44-year-old heart transplant recipient presenting with gastroduodenitis, pancreatitis, and hepatitis. On histopathologic examination, the gastric, duodenal, and bile ductular epithelium showed a multinucleate giant cell transformation similar to the cytopathic effect caused by the virus in human T-lymphocytes infected in vitro. Electron microscopy showed herpes particles with a thick tegument layer in the duodenum. Polymerase chain reaction amplified HHV-6 variant A sequences from multiple sites. Serology confirmed the presence of an acute HHV-6 infection. Thus, HHV-6 variant A can cause gastroduodenitis and pancreatitis in immunosuppressed individuals. Multinucleate giant cells and enveloped virions with a prominent tegument can be used as morphologic criteria to raise the possibility of HHV-6 infection in human biopsy tissue.

From the Division of Transplantation Pathology, Department of Pathology, Division of Behavioral Medicine and Oncology, University of Pittsburgh Cancer Institute, and Division of Transplantation Medicine, Departments of Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Address correspondence to Dr. P.S. Randhawa, Division of Transplant Pathology, Presbyterian University Hospital, Pittsburgh, PA 158S13, USA.

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