A 68-year-old woman had a peculiar clinical course of cutaneous lymphoma. She first developed nonpuritic erythematous macules with fine scales followed by development of erythematous infiltrated plaques. The clinical course could be interpreted as that of mycosis fungoides. Histologically, the lesions showed pagetoid infiltration of atypical lymphoid cells. Suddenly, with high fever, numerous purpuric, ulcerated, or crusted plaques with underlying infiltration or nodules began to appear on most areas of the patient's body. Biopsy specimens of the lesions revealed angiocentric and angiodestructive infiltration by neoplastic T cells and marked epidermotropism of these cells. These atypical cells immunohistochemically had CD8+ surface phenotype. The patient died of respiratory insufficiency due to acute pulmonary infiltration. Autopsy demonstrated angiocentric and angiodestructive lymphomatous infiltration in the lung.
A new method for detection of varicella-zoster virus (VZV) DNA using field-inversion gel electrophoresis (FIGE) was devised.VZV-genomic DNA could be differentiated from the host cell DNA of human embryonic lung (HEL) fibroblasts infected with VZV under electrophoretic conditions allowing resolution of linear and double-stranded DNAs in the 49-230 kilobase pairs (Kb) range. The detection of VZV-genomic DNA from infected HEL cells was successful regardless of whether the VZV was a laboratory strain, live vaccine strain, or fresh isolate. Under the same electrophoretic conditions, DNA of VZV-infected HEL cells could be clearly differentiated from DNA obtained from HEL cells infected with herpes simplex virus type 1 (HSV-1), type 2 (HSV-2), or human cytomegalovirus (HCMV). Furthermore, VZV genomic DNA could be detected from as small a sample as 1.9 \ 104 VZV-infected HEL cells. Finally, we could detect VZV genomic DNA from 10 samples of vesicle tissue (blister lids, each about 1-4 mm2) and one sample of vesicle fluid (about 5 pl) obtained from patients diagnosed as having herpes-zoster. The results of' this study indicate that FIGE is a simple and promising method for the detection of VZV from clinical materials as well as infected in vitro cultured cells.VZV is known to cause two diseases, varicella and zoster. The former is an acute disease that follows primary contact with the virus, whereas the latter is the response of the partially immune host to a reactivation of VZV present in latent form in sensory ganglia (13).Several methods are in use for laboratory diagnosis of VZV infection; (a) virus isolation in cultures, followed by identification of' the isolate by various tests; (b) viral antigen detection by immunofluorescence test of clinical materials; (c) virus particle detection by electron microscopy ; and (d) viral nucleic acid detection using a hybridization technique (7)(8)(9)20).Virus isolation and identification is timeconsuming. In contrast, viral antigen detection from lesions is simple and rapid, and has high sensitivity and specificity. The test, however, can be negative even in clinical cases of VZV infection when only a small amount of viral antigen is
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