Acta Dermato-Venereologica 97-4 | Page 33

537 SHORT COMMUNICATION Human Herpesvirus-7 Papular Rash in a Healthy Adult Patient Valeria BRAZZELLI 1 , Chiara GIORGINI 1 , Stefania BARRUSCOTTI 1 , Gorgio A. CROCI 2 and Giovanni BORRONI 1 Institute of Dermatology, Department of Clinical-Surgical, Diagnostic and Pediatric Science, and 2 Department of Pathology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia, Italy. E-mail: [email protected], [email protected] 1 Accepted Nov 8, 2016; Epub ahead of print Nov 9, 2016 Human herpesviruses (HHVs) are frequently considered as aetiological agents or cofactors in cutaneous diseases (1). However, clearly established HHV-7 associations are rare. We describe here a case in which diagnostic techniques led to viral detection and a better dermato- logical diagnosis. CASE REPORT A 50-year-old man was referred to the department of dermatology with a diffuse erythemato-papular rash, spreading from the trunk to the limbs and neck, accom- panied by intense pruritus (Fig. 1). The patient’s medical history was unremarkable, no prodromal symptom was present, and he denied drug use, both routinely and in the days before the eruption. Laboratory investigations were negative or within normal ranges, except for mild lymphocytosis (3.9 × 10 3 /mm 3 ; normal range 1.5–3 × 10 3 /mm 3 ). A diagnosis of urticaria papulosa/insect bites was suspected. The patient returned 3 days later due to persistent lesions. Skin biopsies were performed and the histolo- gical findings showed an interface dermatitis, with rare lymphocytes along the dermo-epidermal junction, and a scarce, superficial perivascular lymphocytic infiltrate. The epidermis showed a mild spongiosis, lymphocytes exocytosis and rare single necrotic keratinocytes. No eosinophils were evident. An orthokeratotic stratum corneum with a preserved basket-weave aspect was seen, demonstrating the acute nature of the process (Fig. 2). The most common infectious agents associated with cutaneous rashes (secondary syphilis, HSV 1–2, VZV, Fig. 1. Erythematous papular eruption on the trunk. CMV, EBV, HHV-6, HCV, HBV, HIV, parvovirus B19, Coxsackie and echovirus) were excluded by serological testing or count of DNA copies in blood samples. The only notable finding was the detection of circulating HHV-7 DNA (800 copies/ml) in the blood, which is considered significant for active infection. A diagnosis of HHV-7 related papular rash was suggested. Four weeks after the beginning of the eruption, the rash cleared completely without scaling and HHV-7 DNA was undetectable in blood samples. DISCUSSION HHV-7 was discovered in 1990 as a new member of the beta-herpesvirus subfamily. It is closely related to HHV- 6, sharing a strong genetic homology and the CD4 + cells tropism (1). Fig. 2. Histological examination of a papule: (a) An interface dermatitis, with lymphocytes along the dermo-epidermal junction, and a scarce, superficial, perivascular lymphocytic infiltrate (haematoxylin and eosin (H&E) ×10). (b) The epidermis shows a mild spongiosis, lymphocytes exocytosis and rare single necrotic keratinocytes. No eosinophils are evident. The stratum corneum is orthokeratotic, with a preserved basket-weave aspect (H&E ×40). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2567 Acta Derm Venereol 2017; 97: 537–538