Burnett Joseph W, Laing Jennifer M, Aurelian Laure
Department of Dermatology, University of Maryland, 4401 Roland Ave, Baltimore, MD 21210, USA.
Arch Dermatol. 2008 Jul;144(7):902-7. doi: 10.1001/archderm.144.7.902.
Patients with stem cell transplantation (SCT) develop erythematous eruptions (SCTE) that are often misdiagnosed and poorly treated. Latent herpes simplex virus (HSV) is likely to be reactivated by SCT-associated immunosuppression. Therefore, one of the differential diagnostic possibilities for SCTE is HSV-associated erythema multiforme (HAEM) in which HSV genetic fragments localize in stem cells that deliver them to the skin on differentiation.
Lesional skin from patients with SCTE, HAEM, HSV, or drug-induced erythema (DIEM) was stained with antibodies to the HSV antigen DNA polymerase (Pol) and the major capsid protein, virion protein 5 (VP5). The HSV DNA polymerase Pol was expressed in 79% of patients with SCTE and 75% of those with HAEM. The protein VP5 was not expressed in these patients, indicative of the absence of virus replication. Findings in patients with DIEM were negative for both antigens, and those with HSV lesions were positive for both antigens.
There is a growing problem with SCTE, related to the increasing numbers of performed SCT. The greater frequency of SCT-generated circulating stem cells in patients with hematological malignant neoplasms (who have latent HSV infection) may result in a widespread SCTE characterized by skin deposition of HSV DNA fragments, notably those expressing Pol antigen. This HAEM-like presentation should be considered in the differential diagnosis of SCTE. Prolonged high-dosage antiviral chemotherapy during and after hospitalization may be warranted.
干细胞移植（SCT）患者会出现红斑疹（SCTE），这类病症常被误诊且治疗效果不佳。潜伏的单纯疱疹病毒（HSV）很可能因SCT相关的免疫抑制而重新激活。因此，SCTE的鉴别诊断可能性之一是HSV相关多形性红斑（HAEM），其中HSV基因片段定位于干细胞中，这些干细胞在分化时将其传递至皮肤。
对SCTE、HAEM、HSV或药物性红斑（DIEM）患者的皮损进行染色，使用针对HSV抗原DNA聚合酶（Pol）和主要衣壳蛋白病毒体蛋白5（VP5）的抗体。79%的SCTE患者和75%的HAEM患者中表达了HSV DNA聚合酶Pol。这些患者中未表达蛋白VP5，表明不存在病毒复制。DIEM患者的两种抗原检测结果均为阴性，而HSV皮损患者的两种抗原检测结果均为阳性。
随着SCT实施数量的增加，SCTE问题日益突出。血液系统恶性肿瘤患者（存在潜伏HSV感染）中SCT产生的循环干细胞频率更高，可能导致以HSV DNA片段皮肤沉积为特征的广泛SCTE，尤其是那些表达Pol抗原的片段。在SCTE的鉴别诊断中应考虑这种类似HAEM的表现。住院期间及出院后可能需要延长高剂量抗病毒化疗。
