Original Article Detection of Human Herpesvirus DNA in Kikuchi-Fujimoto Disease and Reactive Lymphoid Hyperplasia
S. David Hudnall, Tiansheng Chen, Samir Amr, Ken H. Young and Kristin Henry
Department of Pathology, University of Texas Medical Branch, Galveston, TX; Pathology Services Division, Dhahran Health Center, Dhahran, Saudi Arabia; Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Histopathology, Charing Cross Hospital, Imperial College London, United Kingdom
Received 23 Aug 2007; accepted with revision 27 Sept 2007; available online 1 January 2008
Abstract: Kikuchi-Fujimoto disease (KFD), or histiocytic necrotizing lymphadenitis, is a subacute inflammatory disorder most often seen in young women with clinicopathologic features suggestive of an infectious etiology. The most commonly suspected infectious agents in KFD are the human herpesviruses EBV, HHV6, HHV7 and HHV8. In order to identify herpesviruses in KFD, we have compared the frequency of detection of herpesvirus DNA with a recently developed real time PCR method, EBER in situ hybridization, and EBV latent membrane protein (LMP) immunostaining in 30 cases of KFD and 12 cases of reactive lymphoid hyperplasia (RLH). EBV DNA was commonly detected, while HSV2, CMV, HHV6, and HHV7 DNA were seldomly detected, and HSV1, VZV, and HHV8 DNA were not detected in KFD. EBV was also commonly detected in RLH. EBER-positive cells with apoptotic features were identified in necrotizing regions of many KFD cases, and LMP-positive cell debris was detected in one case. Viable EBER-positive cells were identified in four of twelve RLH cases, and rare LMP positivity detected in three cases. These data lend support to the notion that the necrotizing lesions in KFD may in some cases be due to a vigorous immune response to EBV-infected lymphoid cells. (IJCEP708011).
Key Words: Herpesvirus, Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis, reactive lymphoid hyperplasia, Epstein-Barr virus, real time PCR