Angioimmunoblastic lymphadenopathy with disseminated human herpesvirus 6 infection in a patient with acute myeloblastic leukemia

Abstract

A 47-year-old man with acute myeloblastic leukemia (AML) developed angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) 4 months after induction chemotherapy for AML. During a leukopenic period, the patient suffered from pericarditis with massive pericardial effusion in which human herpesvirus 6 (HHV-6) DNA was detected. Although complete remission of AML was achieved, fever persisted and atypical skin rash followed by generalized lymphadenopathy along with polyclonal hypergammaglobulinemia appeared. A diagnosis of AILD was made on a biopsy specimen of the inguinal lymph node. The patient died of fulminant hepatitis and the autopsy showed lymphomatous infiltrates involving the liver, bone marrow, lungs, spleen, kidneys and heart. HHV-6 DNA sequences were identified in the biopsy specimen of the lymph node and in the involved organ tissues. HHV-6 in this patient was variant B. It is known that HHV-6 can be reactivated in immunocompromised patients and causes severe complications. This unusual clinical course suggests that the immunosuppression associated with AML and the additional iatrogenic immunosuppression following cytopenia-inducing chemotherapy predisposed the patient to reactivated HHV-6 infection. The sequential detection of this virus before and after manifestation of AILD may support the evidence that HHV-6 infection could directly or indirectly trigger AILD. This is the first time that such a sequence of events has been reported to our knowledge. The possibility of HHV-6 infection should be considered when unexplained fever and generalized lymphadenopathy are seen in patients with leukemia, and administration of antiviral agents should be considered for the diagnostic evaluation.