Presence of herpes simplex virus (HSV) in peripheral leukocytes of patientwho developed active HSV infection after bone marrow transplantation

Background: Despite of prophylactic antiviral therapy, latent HSV may be re activated in bone marrow transplant (BMT) recipients and cause serious dise ase. Rapid diagnosis of HSV infection is needed to prompt institution of ap propriate therapy. Objectives: We report a case of the allogenic BMT recipi ent, who developed ulcerative esophagitis which progressed to generalized H SV infection and graft versus host reaction (GVHR). We consider several dia gnostic approaches to detection of active HSV infection in this patient. St udy design: Polymerase chain reaction (PCR) was used to detect HSV DNA in e sophageal biopsy specimens and peripheral leukocytes (PBL). Isolation of HS V in tissue culture was performed to prove infectious virus in swabs from m ucocutaneous lesions or in PBL. Results: Using PCR, HSV DNA was detected in peripheral leukocytes of the patient who had developed generalized HSV inf ection accompanied with hepatosplenomegaly and hepatitis. At that time, a f ully infectious ACV-resistant HSV was isolated from his PBL. On the other h and, HSV DNA was not detected in PBL of other BMT-recipients with skin- or organ-localized infection. Conclusions: Presence of HSV-DNA in PBL of BMT r ecipients can signalize generalized HSV infection. Isolation of HSV from PB L by cocultivation with human fibroblasts can be used as an alternative dia gnostic approach in these patients. (C) 2000 Elsevier Science B.V. All righ ts reserved.