水痘-带状疱疹病毒毛囊炎促进克隆性淋巴样增生

作     者：Aram G Rohwedder A Nazeer T J.A. Carlson 党倩丽 

作者机构：Albany Medical College MC-81 47 New Scotland Ave. Albany NY 12208 United States.Dr 

出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)

年 卷 期：2006年第2卷第1期

页      面：23-24页

学科分类：1002[医学-临床医学] 100206[医学-皮肤病与性病学] 10[医学] 

主　　题：淋巴样 克隆性 带状疱疹 抗原缺失 皮肤结节 细胞群 伐昔洛韦 生发中心 基因重排 细胞过度增生 

摘      要：Post herpes zoster (HZ) reactions have been associated with panoply of neoplastic, inflammatory, and fibro-inflammatory cutaneous disorders. Varicella zoster virus (VZV) DNA has not been identified in most of these reports. After an episode of HZ, a healthy, active 90-year-old female developed ulcerative nodules in the affected trigeminal V1 dermatome and the contra-lateral trigeminal region over a 1-year period. Excision and/or biopsy of all these lesions showed similar pathologic changes that consisted of herpetic folliculitis, adjacent dense mixed nodular lymphocytic infiltrates with germinal centers (cutaneous lymphoid hyperplasia (CLH)), and in the deeper excision specimens, an obliterative vasculitis of a vessel with smooth muscle in its wall. Immunophenotype analysis revealed a mixed, predominate T-and B-cell population without loss of pan-T cell antigens or aberrant expression by B cells of T-cell antigens. Polymerase chain reaction for herpetic DNA was po sitive for VZV DNA. Lymphocyte gene rearrangement analysis revealed 2 distinct, anatomically and chronologically, monoclonal B-cell populations and a monoclona l T-cell population in one nodule. Treatment with valacyclovir has lead to almo st complete resolution of her cutaneous nodules after 6 months of therapy. In th is case, it can be surmised that persistence of VZV infection and lack of effect ive cell-mediated immunity lead to development of both immunopathology (vasculi tis) and excessive lymphoid cell proliferation (CLH).