Herget Georg Werner, Riede Ursus Nikolaus, Schmitt-Gräff Annette, Lübbert Michael, Neumann-Haefelin Dieter, Köhler Gabriele
Department of Orthopedics and Traumatology, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg i. Br., Germany.
Pathol Res Pract. 2005;201(2):123-9. doi: 10.1016/j.prp.2004.12.003.
Patients with immunodeficiency or treatment-related immunosuppression are at an increased risk of developing severe herpes simplex virus (HSV) infection. We present a fatal case of a generalized HSV-1 infection in a 22-year-old female afflicted by acute lymphoblastic leukemia who was treated with polychemotherapy. The terminal clinical course was characterized by abdominal pain, progressive hepatic failure, and disseminated intravascular coagulation. Autopsy revealed non-perioral herpetic skin lesions and mucosal ulceration of the esophagus and colon. Punctuated areas of yellow-tan necrosis with hyperemic rims were detected in the liver, spleen, and lung. Numerous petechiae were observed on the mucosal surface of the esophagus, jejunum, ileum, and colon. Microscopically, lesions demonstrated the cellular changes characteristic of herpetic infection. Immunohistochemistry for identification of the virus using monoclonal antibodies against HSV-1 and HSV-2 showed positive staining for HSV-1. Polymerase chain reaction and sequencing confirmed HSV-1 positivity. Emphasis must be placed on clinical awareness of a generalized HSV infection in immunocompromised patients. Absence of orofacial or genital lesions does not rule out the possibility of active HSV infection.
免疫缺陷或治疗相关免疫抑制的患者发生严重单纯疱疹病毒（HSV）感染的风险增加。我们报告一例22岁急性淋巴细胞白血病女性患者，接受多药化疗后发生全身性HSV-1感染并死亡的病例。终末期临床过程的特征为腹痛、进行性肝衰竭和弥散性血管内凝血。尸检发现非口周疱疹性皮肤病变以及食管和结肠黏膜溃疡。在肝脏、脾脏和肺中检测到有充血边缘的黄棕色坏死点状区域。在食管、空肠、回肠和结肠的黏膜表面观察到大量瘀点。显微镜下，病变显示出疱疹感染的特征性细胞变化。使用抗HSV-1和HSV-2单克隆抗体进行病毒鉴定的免疫组织化学显示HSV-1染色呈阳性。聚合酶链反应和测序证实HSV-1阳性。必须重视免疫功能低下患者全身性HSV感染的临床意识。口面部或生殖器无病变并不能排除HSV活动性感染的可能性。
