Human herpes virus 8 replication during disseminated tuberculosis in a man with human immunodeficiency virus: a case report

Article Article scientifique Rapport de cas Human herpes virus 8 replication during disseminated tuberculosis in a man with human immunodeficiency virus: a case report eng 2009 author Inoubli Sarra Dominique 507692 author Toutous Trellu Laurence Marie 0000-0001-8087-1161 503969 author Cathomas Gieri author Oksenhendler Eric author Hirschel Bernard 22746 author El Amari E. B. 113 10.1186/1752-1947-3-113 19946591 1752-1947 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783054/pdf/1752-1947-3-113.pdf INTRODUCTION: Human herpes virus 8 (HHV-8) is mainly responsible for the development of Kaposi's sarcoma and multicentric Castleman's disease in immunocompromised patients with untreated human immunodeficiency virus. Positive viral loads have been described in cases of Kaposi's sarcoma and multicentric Castleman's disease, with higher values found in the latter. We describe the case of a patient with HIV in whom a high level of HHV-8 replication was detected and who contracted an opportunistic disease other than multicentric Castleman's disease or Kaposi's sarcoma. CASE PRESENTATION: A 25-year-old man of West African origin with HIV complained of asthenia, weight loss, fever, and abdominal pain. Physical examination revealed that the patient had adenopathies and hepatosplenomegaly, but no skin or mucosal lesions were seen. Our first presumptive diagnosis was disseminated tuberculosis. However, since the cultures (sputum, bronchoalveolar lavage, blood, urine and lymph node biopsies) for mycobacteria were negative, the diagnosis was expanded to include multicentric Castleman's disease which was supported by high HHV-8 viral loads in the patient's blood: 196,000 copies/ml in whole blood, 39,400 copies/ml in plasma and 260 copies/10E5 in peripheral blood mononuclear cells. However, the histology and positive polymerase chain reaction assay for Mycobacterium tuberculosis complex of a second lymph node biopsy enabled us to conclude that the patient had disseminated tuberculosis and we started the patient on antituberculosis treatment. We analyzed the HHV-8 deoxyribonucleic acid in two other plasma samples (one from six months earlier and the other was 10 days after the positive test) and both yielded negative results. A search for latent and lytic HHV-8 antibodies confirmed that the patient was seropositive for HHV-8 before this episode. CONCLUSION: We describe the case of a patient with HIV who tested positive for asymptomatic HHV-8 replication during an opportunistic disease suggestive of multicentric Castleman's disease. The initial analysis was nullified by the diagnosis of a disease that was unrelated to HHV-8. This case report underlines the need to clarify the full clinical meaning and implication of a positive HHV-8 viral load in patients with AIDS. The diagnosis of multicentric Castleman's disease needs to be studied further to determine its sensitivity and specificity. Finally, when faced with the dilemma of urgently starting chemotherapy on a patient whose condition is deteriorating and whose clinical presentation suggests multicentric Castleman's disease, high HHV-8 viral loads should be interpreted with caution and histological analysis of lymph nodes or liver biopsies should be obtained first. Dewey 576.5 135 Département de médecine génétique et développement 21D false Journal of medical case reports 3 5b958842-534f-4302-b7fa-cc7e62ff87f0 Article Public file1.pdf 222499 application/pdf openAccess Faculté de médecine / Section de médecine fondamentale / Département de médecine génétique et développement

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Human herpes virus 8 replication during disseminated tuberculosis in a man with human immunodeficiency virus: a case report	Journal of medical case reports			2009	692	612

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Inoubli, Sarra Dominique