HERPESVIRUS-6 VARIANT-A INFECTION AFTER HEART-TRANSPLANTATION WITH GIANT-CELL TRANSFORMATION IN BILE DUCTULAR AND GASTRODUODENAL EPITHELIUM

Herpesvirus 6 (HHV-6) is a ubiquitous virus known to cause febrile syn dromes and exanthema subitum in children. Less commonly, and particula rly in organ transplant recipients, it may result in hepatitis, bone m arrow suppression, interstitial pneumonitis, and meningoencephalitis. This report expands the spectrum of clinical disease associated with H HV-6 by documenting viral infection in a 44-year-old heart transplant recipient presenting with gastroduodenitis, pancreatitis, and hepatiti s. On histopathologic examination, the gastric, duodenal, and bile duc tular epithelium showed a multinucleate giant cell transformation simi lar to the cytopathic effect caused by the virus in human T-lymphocyte s infected in vitro. Electron microscopy showed herpes particles with a thick tegument layer in the duodenum. Polymerase chain reaction ampl ified HHV-6 variant A sequences from multiple sites. Serology confirme d the presence of an acute HHV-6 infection. Thus, HHV-6 Variant A can cause gastroduodenitis and pancreatitis in immunosuppressed individual s. Multinucleate giant cells and enveloped virions with a prominent te gument can be used as morphologic criteria to raise the possibility of HHV-6 infection in human biopsy tissue.