RESUMEN
BACKGROUND: Cutavirus (CuV) is associated with mycosis fungoides; however, the CuV status in parapsoriasis en plaques (PP), a premalignant inflammatory condition of mycosis fungoides, has not been fully delineated. METHODS: Fifty-five Japanese patients with chronic inflammatory skin diseases, including 13 patients with PP, were studied. RESULTS: CuV DNA was detected significantly more frequently in biopsies of the lesional skin from patients with PP (38%; 4 of 13) than in those from patients with other inflammatory skin diseases (2%; 1 of 42; P = .009). All CuV-positive PP cases were of the large-plaque parapsoriasis (LPP) subtype. The viral loads ranged from 83 450 to 2 164 170 copies/103 cells. We recovered near-full-length CuV sequences from the CuV-positive LPP biopsies, all of which were of the Japanese/Asian genotype. The CuV genome appeared to be present within lymphoid cells infiltrating the epidermis and dermis. CuV NS1 and VP1 gene transcripts were also detected in the affected tissues. CONCLUSIONS: The detection of high levels of CuV DNA with the expression of viral mRNA suggests a potential role for CuV in the pathogenesis of LPP, making it necessary to study further the impact of CuV, especially regarding the viral genotype, on the outcomes of patients with CuV-positive LPP.
Asunto(s)
Micosis Fungoide , Parapsoriasis , Humanos , Micosis Fungoide/virología , Micosis Fungoide/patología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Parapsoriasis/virología , Parapsoriasis/patología , Adulto , ADN Viral/genética , Piel/patología , Piel/virología , Carga Viral , Japón , Anciano de 80 o más Años , Biopsia , Neoplasias Cutáneas/virología , Neoplasias Cutáneas/patología , Lesiones Precancerosas/virología , Lesiones Precancerosas/patología , Virus ADN/genética , Virus ADN/aislamiento & purificación , Virus ADN/clasificaciónRESUMEN
BACKGROUND: To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. CASE PRESENTATION: The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectatic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died. The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing. CONCLUSIONS: The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.
Asunto(s)
COVID-19/patología , Dermatitis Exfoliativa/patología , Endotelio Vascular/patología , Parapsoriasis/patología , SARS-CoV-2/patogenicidad , Piel/patología , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/virología , Dermatitis Exfoliativa/tratamiento farmacológico , Dermatitis Exfoliativa/virología , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/virología , Resultado Fatal , Interacciones Huésped-Patógeno , Humanos , Masculino , Parapsoriasis/tratamiento farmacológico , Parapsoriasis/virología , Piel/efectos de los fármacos , Piel/virología , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19RESUMEN
BACKGROUND: Human herpesvirus (HHV) 8, an essential etiologic agent of Kaposi sarcoma, is also associated with several lymphoproliferative disorders. The involvement of HHV 8 in mycosis fungoides (MF) and large plaque parapsoriasis (LPP) is controversial, with contradictory reports from various countries worldwide. OBJECTIVE: We sought to investigate the presence of the HHV 8 genome in skin lesions of LPP and early-stage sporadic, familial, and juvenile MF in patients in Israel. METHODS: Archival paraffin-embedded and frozen samples from skin biopsies of untreated patients with LPP and early-stage MF performed in 1990 through 2006 were randomly collected from the department of dermatology of a tertiary medical center in central Israel. DNA was extracted, and a TaqMan-based real-time polymerase chain reaction assay specific for the K6 gene region was used to detect the HHV 8 genome. RESULTS: A total of 46 biopsies were sampled from 11 patients with LPP and 35 with early-stage MF (17 adults with sporadic MF, 10 children, and 8 patients with familial MF). In all, 44 samples were negative for HHV 8 DNA; two samples from adults with sporadic MF were positive. LIMITATIONS: The presence of HHV 8 antibodies or virus sequences was not assessed in peripheral blood. CONCLUSION: The results of this study, conducted in a region relatively endemic for HHV 8, support most earlier studies showing a lack of association of HHV 8 infection with LPP and sporadic adult-type MF. To our knowledge, the lack of association of HHV 8 infection with juvenile and familial MF has not been previously reported.
Asunto(s)
Herpesvirus Humano 8/aislamiento & purificación , Micosis Fungoide/virología , Parapsoriasis/virología , Piel/virología , Adulto , Niño , Computadoras de Mano , ADN Viral/análisis , Humanos , Micosis Fungoide/genéticaAsunto(s)
Monkeypox virus/patogenicidad , Mpox/diagnóstico , Parapsoriasis/virología , Adolescente , Animales , República Centroafricana , ADN Viral , Humanos , Masculino , Análisis por Micromatrices , Mpox/virología , Monkeypox virus/genética , Aislamiento de Pacientes , Zoonosis/transmisión , Zoonosis/virologíaRESUMEN
To investigate the potential role of CMV in cutaneous T-cell lymphoma (CTCL), we studied cytomegalovirus (CMV) seroprevalence in parapsoriasis (PP), mycosis fungoides (MF) and Sézary syndrome (SS) compared with healthy control patients. In cases where CMV seropositivity was observed, CMV PCR analyses were performed on skin biopsies. CMV seroprevalence was 37.1% in the control group, 50.68% in the PP + MF + SS group (P = 0.08), 56.2% in the MF + SS group (P = 0.07), 40% in the PP group (P = 0.9), 66.67% in the MF group (P = 0.009), 42.86% in the SS group (P = 0.9). CMV PCR in initial skin biopsies were all negative. However, PCR CMV was positive in two SS skin biopsies realized at an advanced stage. Our results show that latent CMV infection may play a role in the susceptibility of MF in predisposed subjects by inducing T-cell proliferation and resistance to apoptosis. Concerning SS, an immunosuppressive state may be responsible for CMV reactivation that in turn may interfere with evolution of the disease.
Asunto(s)
Infecciones por Citomegalovirus/epidemiología , Citomegalovirus/patogenicidad , Micosis Fungoide/virología , Parapsoriasis/virología , Síndrome de Sézary/virología , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Biopsia , Comorbilidad , Citomegalovirus/genética , Citomegalovirus/inmunología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/virología , ADN Viral/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Micosis Fungoide/epidemiología , Parapsoriasis/epidemiología , Prevalencia , Estudios Retrospectivos , Estudios Seroepidemiológicos , Síndrome de Sézary/epidemiología , Síndrome de Sézary/inmunología , Piel/virologíaRESUMEN
INTRODUCTION: The aetiology of mycosis fungoides and parapsoriasis (which may be considered as an early stage of mycosis fungoides) remains debated. Previous recent studies have suspected the involvement of viral agents and particularly human herpes viruses (HHV).The aim of the present study was to screen for the presence of HHV-6 and HHV-8 genome in parapsoriasis samples. METHOD: Fifty paraffin-embedded samples from skin biopsies of parapsoriasis were retrospectively collected from archival files in our Dermatology department. Total DNA was extracted from samples using the phenol-chloroform method and the presence of viral genomes was screened using real-time PCR. RESULTS: Forty nine out of the fifty tissue samples of parapsoriasis were interpretable, they were all found negative for HHV-6 and HHV-8. DISCUSSION: This study does not confirm the suspected role of HHV-6 or -8 in parapsoriasis. HHV-8 has been the most studied virus in parapsoriasis and more widely in cutaneous lymphoproliferative diseases and our results are in agreement with most of the studies which found none or few HHV-8 in more advanced stages of cutaneous lymphoproliferative diseases. Concerning HHV-6, our study is the first one investigating the presence of this virus in lesional tissue samples of patients with parapsoriasis. In conclusion, parapsoriasis does not seem to be associated with either HHV-6 or HHV-8.
Asunto(s)
Herpesvirus Humano 6/fisiología , Herpesvirus Humano 8/fisiología , Parapsoriasis/fisiopatología , Parapsoriasis/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Micosis Fungoide/fisiopatología , Micosis Fungoide/virología , Estudios Retrospectivos , Piel/patología , Piel/virología , Adulto JovenRESUMEN
OBJECTIVE: To investigate the presence of human herpesvirus 8 (HHV-8) in lesional skin of German patients with large-plaque parapsoriasis (LPP) or mycosis fungoides (MF). The pathogenetic relevance of HHV-8 in cutaneous T-cell lymphoma is controversial. Recently, a highly significant association of HHV-8 in LPP was found, which suggests a role in the pathogenesis of this disease. DESIGN: Retrospective study of the presence of HHV-8 in German patients with lymphoproliferative diseases. SETTING: Dermatologic clinic at a university hospital of the Ruhr University Bochum, Bochum, Germany. PATIENTS: Fifty-three patients treated for lymphoproliferative skin diseases were included in the study, including 14 patients with LPP, 31 with different stages of MF, and 8 with lymphomatoid papulosis (LyP). Twenty-three patients with Kaposi sarcoma (KS) made up the positive control group, and 10 patients with atopic dermatitis served as negative controls. MAIN OUTCOME MEASURES: The presence of HHV-8 was analyzed from paraffin-embedded lesional tissue samples using a nested polymerase chain reaction for the open reading frame (ORF) 26 and with immunohistochemical staining for the latency-associated nuclear antigen (LANA) encoded by ORF 73. RESULTS: A high association of HHV-8 infection in both lymphoproliferative skin diseases was observed: 87% of LPP and 70% of MF tissue samples tested positive for HHV-8 DNA from ORF 26. However, HHV-8 was not detectable in LPP and MF by using the immunohistochemical marker LANA. CONCLUSIONS: A virus unambiguously associated with KS, HHV-8 was frequently detected at low amounts in LPP and MF specimens. However, based on the methods of HHV-8 detection used in this study, no conclusion can be drawn on the etiologic and pathogenetic role of HHV-8 in these diseases.
Asunto(s)
Infecciones por Herpesviridae/complicaciones , Herpesvirus Humano 8/aislamiento & purificación , Papulosis Linfomatoide/virología , Micosis Fungoide/virología , Parapsoriasis/virología , Neoplasias Cutáneas/virología , Adulto , Anciano , Anciano de 80 o más Años , Antígenos Virales/análisis , ADN Viral/análisis , Dermatitis Atópica/patología , Dermatitis Atópica/virología , Femenino , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Inmunohistoquímica , Papulosis Linfomatoide/patología , Masculino , Persona de Mediana Edad , Micosis Fungoide/patología , Proteínas Nucleares/análisis , Parapsoriasis/patología , Reacción en Cadena de la Polimerasa , Prevalencia , Estudios Retrospectivos , Sarcoma de Kaposi/patología , Sarcoma de Kaposi/virología , Piel/patología , Piel/virología , Neoplasias Cutáneas/patologíaAsunto(s)
Parapsoriasis/virología , Pitiriasis/virología , Adolescente , Adulto , Anciano , Biopsia , Niño , Preescolar , Femenino , Herpesvirus Humano 4/aislamiento & purificación , Herpesvirus Humano 6/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaAsunto(s)
Infecciones por VIH/diagnóstico , VIH-1/aislamiento & purificación , Mononucleosis Infecciosa/diagnóstico , Enfermedad Aguda , Alopecia/virología , Diagnóstico Diferencial , Eritema/virología , Exantema/virología , Infecciones por VIH/inmunología , Humanos , Mononucleosis Infecciosa/terapia , Parapsoriasis/virología , Virosis/diagnósticoRESUMEN
Human herpesvirus 8 (HHV-8) is a new virus which has been reported in Kaposi's sarcoma and some lymphoproliferative disorders such as Castleman's disease and body-cavity-based lymphoma. Because HHV-8 shares homology with Epstein-Barr virus (EBV), we searched for the presence of HHV-8 DNA sequences in various cutaneous T- and B-cell lymphoma by the polymerase chain reaction (PCR). Forty-seven HIV-negative patients with cutaneous lymphoma or large plaque parapsoriasis were enrolled in the study. For the detection of HHV-8 DNA sequences we used PCR followed by a hybridization with a digoxigenin-labelled probe and nested-PCR. HHV-8 DNA sequences could only be detected in a patient with large plaque parapsoriasis. Our study does not suggest any direct implication of HHV-8 in the pathogenesis of most cutaneous lymphoma. Serological studies will be helpful to appreciate if there is an epidemiological link between HHV-8 and cutaneous lymphomas.