Correlation between HHV-6 infection and skin rash after allogeneic bone marrow transplantation

Abstract

Summary:We investigated whether a causal relationship exists between human herpesvirus 6 (HHV-6) and skin rash resembling acute graft-versus-host disease (GVHD) following bone marrow transplantation (BMT). Isolation of HHV-6 was used to monitor active HHV-6 infection in this study. We analyzed 25 episodes of skin rash in 22 recipients. All recipients were seropositive for HHV-6 before BMT. The onset of skin rash started prior to 30 days post transplantation (group A) in 15 of 25 cases, but after that (group B) in the remaining 10 cases. Twenty-five skin tissue samples were obtained from 22 recipients. The HHV-6 genome was detected in four of 15 skin samples from group A, but not detected in those from group B. HHV-6 was isolated from 11 of 22 recipients around 2 to 3 weeks after BMT (range 14 to 28 days after BMT). HHV-6 was isolated at a time between 10 days before and after the onset of skin rash (skin rash-related viremia) in nine cases in group A. Meanwhile, no skin rash-related viremia was observed in group B. Of the four recipients with positive detection of HHV-6 genome in their skin tissue (group A), two had HHV-6 viremia at the same time. The association between the timing of HHV-6 infection and the onset of skin rash was analyzed statistically. HHV-6 viremia (skin rash-related viremia) was found in nine of 15 (60%) cases in group A, compared with none of 10 (0%) cases in group B. This difference was statistically significant (P = 0.008). Moreover, HHV-6 infection (skin rash-related viremia and/or positive detection of HHV-6 DNA in skin tissue) was demonstrated in 11 of 15 (73.3%) cases in group A, compared with none of 10 (0%) cases in group B (P = 0.001). Thus, this study suggests that HHV-6 may be involved in the development of skin rash in the first month after allogeneic BMT. Bone Marrow Transplantation (2001) 28, 77-81.

Human Herpesvirus 6 Reactivation in Trichloroethylene‐exposed Workers Suffering from Generalized Skin Disorders Accompanied by Hepatic Dysfunction

“…HHV-6 infects most children between 6 months and 2 yr of age causing exanthema subitum 18) . The virus remains latent after primary infection and is then reactivated during immunosuppressive conditions such as lymphoproliferative disorders 31) and transplantation of bone marrow 32,33) , kidney 34) or liver 35) , often in relation to the rash33). In drug-induced HS, IgG titers against HHV-6 rise remarkably between the 3rd and 4th weeks after the onset of clinical manifestations, and active HHV-6 replication precedes the rise in antibody titers 23) .…”

Thrombotic microangiopathy (TMA) and stroke due to human herpesvirus‐6 (HHV‐6) reactivation in an adult receiving high‐dose melphalan with autologous peripheral stem cell transplantation

“…Its pathogenicity has only recently been appreciated in organ and stem cell/bone marrow transplant patients with a growing number of reports linking its reactivation to rare but significant complications. Indeed, it has been associated with significant clinical sequelae, which include meningoencephalitis, seizures, thrombocytopenia, rash [8], bone marrow suppression [9], graft failure [10,11], interstitial pneumonitis, and thrombotic microangiopathy. The latter has only recently being recognized in children undergoing transplantation [12,13].…”

Infecciones más comunes en el paciente trasplantado

“…En España, la infección por este gusano es poco prevalente, pero se debe sospechar en pacientes que han vivido en áreas endémicas 61 . La infestación por larvas de Strongyloides stercoralis en pacientes trasplantados reviste los mismos riesgos que en otro tipo de pacientes inmunocomprometidos, en los que una infección asintomática puede convertirse en una enfermedad diseminada o en un síndrome de hiperinfección.…”