Epstein–Barr Virus in Cutaneous Pathology

Abstract

Epstein-Barr virus (EBV) is a ubiquitous double-stranded DNA gamma herpes virus and it is present in 95% of adults. EBV infection is seen in many oncological conditions, although there is controversy regarding whether EBV is causative, a cofactor, or just a coincidental infection. Some of these conditions involve the skin as the main or as a secondary organ. In this report, we review several tumoral and nontumoral cutaneous conditions, which are related to EBV infection, and describe the epidemiology of infection and the life cycle of the virus.

Lymphocytic Arteritis in Epstein–Barr Virus Vulvar Ulceration (Lipschütz Disease)

“…2,23 The detection and replication of EBV in genital skin and our finding of EBV LMP1 expressing endothelial cells and vascular myocytes supports the theory of direct cell-lysis by EBV. 23,34,36 However, the absence of detection of EBV DNA by EBER ISH in lesional keratinocytes or vessel wall constituents, but its presence in lymphocytes points to a host immunopathologic response instead of lytic EBV infection. 2 Formation and deposition of immune complexes have been demonstrated in infectious mononucleosis, 23,38 and multiple reports describe leukocytoclastic vasculitis in EBVVU.…”

“…Paradoxically, lytic infection affects epithelia, not B lymphocyes. 34 The former explains localization of disease. Given the above, EBV infection, primary or reactivated, of vessel wall constituents such as endothelial cells and myocytes could be the target of immune response, specifically arteritis, leading to characteristic ulceration found in EBVVU.…”

“…As EBV is cleared, a latent viral stage will be adopted in some infected B cells, which can persist for the life of a patient. 34 Under normal physiologic conditions, host immunity controls the overall number of EBV-infected cells at low levels. However, certain conditions such as immunosuppression, reactivation of EBV occurs allowing replicative infection and increased viral load.…”

“…34 In children, primary infection is asymptomatic, whereas symptomatic infectious mononucleosis occurs in 30%-70% of adolescents. Clinically, the classic triad of fever, pharyngitis, and lymphadenopathy can diagnose acute EBV infection.…”

“…EBV infects B cells, T cells, natural killer cells, macrophages, monocytes, myocytes, keratinocytes-oropharyngeal and genital, semen, cervical secretions, and endothelial cells. [34][35][36] The lytic phase of infection is most commonly seen during primary infection and is controlled by CD8 + cytotoxic T cells, which kill infected cells. As EBV is cleared, a latent viral stage will be adopted in some infected B cells, which can persist for the life of a patient.…”