Transient Angiolymphoid Hyperplasia and Kaposi's Sarcoma after Primary Infection with Human Herpesvirus 8 in a Patient with Human Immunodeficiency Virus Infection

Abstract

DNA sequences of human herpesvirus 8 (HHV-8) have been detected in all forms of Kaposi's sarcoma.^1-3 HHV-8 has also been detected in primary effusion lymphomas,⁴ Castleman's disease,⁵ and multiple myeloma⁶ and reported anecdotally in cases of angioimmunoblastic lymphadenopathy and germinal-center hyperplasia.⁷ Indirect immunofluorescence and immunoblot assays, based on antigens from a latently infected lymphoma cell line, have shown that HHV-8 is not a ubiquitous viral infection in humans. The overall seroprevalence of HHV-8 is less than 5 percent in the United States and United Kingdom, up to 35 percent in southern Italy, and over 50 percent in East Africa.^8-13 Seroconversion has been documented in stored serum samples from homosexual men enrolled in a large cohort study and was associated with a high risk of Kaposi's sarcoma within two years after seroconversion.¹⁴ It is controversial whether primary infection with HHV-8 produces an acute clinical syndrome. We describe a patient infected with human immunodeficiency virus (HIV) who had a sudden onset of fever, arthralgia, cervical lymphadenopathy, and splenomegaly that spontaneously resolved within eight weeks. Pathological examination of the cervical nodes identified angiolymphoid hyperplasia and foci of Kaposi's sarcoma. Retrospective study of stored serum demonstrated recent seroconversion to positivity for HHV-8.