276 HSV Infection With Florid T-Cell Proliferation Mimicking Lymphoma in an HIV-Positive Man Presenting With Leukoplakia and Tender Oral Masses. (11th January 2018)

• Record Type: Journal Article
• Authors: Zafar, Rabia; Hassan, Muhammad Masood; Khan, Farhan; Naab, Tammey
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S117
• Page End: S118
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx123.275
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Herpes simplex virus (HSV) HSV1/HSV2, a nuclear replicating enveloped DNA virus of Herpesviridae family, is usually acquired through direct contact with infected lesions or body fluids, typically saliva with HSV1. HSV can cause both mucocutaneous lesions as well as systemic disease, depending upon the host immune response. The most severely affected individuals are neonates and adults with immunocompromised status. We report a case of a 61-year-old man, recently diagnosed as being HIV positive, who presented with complaint of white, firm, tender masses on the floor of the mouth. Incisional biopsy of the lesion showed mucosal ulceration tissue eosinophilia, and florid lymphoid proliferation. Rare plasma cells were seen. Focally present were viral cytopathic changes, including multinucleation, nuclear molding, and margination of chromatin consistent with HSV infection. Lymphocytes were positive for CD3, CD5, and CD7. CD4-positive lymphocytes predominated. Few CD8-positive cells were present. Rare CD20-positive B-cells were present. Peripheral T-cell lymphoma was a diagnostic consideration. A polyclonal pattern of T-cell receptor gamma gene amplification was detected, hence, ruling out T-cell lymphoma. Several histiocytes were detected with positive CD163 immunostain but negative for CD1a ruling against Langerhans cell histiocytosis. CD15 was only positive in eosinophils; this finding ruled against a diagnosis of Hodgkin lymphoma. HSV1/HSV2 immunostain was positive, confirming the diagnosis of HSV infection. Although Epstein-Barr-virus is the usual cause of oral leukoplakia in an HIV-positive patient, HSV can also be associated with leukoplakia. Our case also reflects an unusual presentation of HSV with a florid T-cell proliferation mimicking lymphoma.