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: email@example.com).
The authors have no funding or conflicts of interest to disclose.