Clinicopathologic Analysis of Coxsackievirus A6 New Variant Induced Widespread Mucocutaneous Bullous Reactions Mimicking Severe Cutaneous Adverse Reactions

被引：58

作者：

Chung, Wen-Hung ^{[1
]}

Shih, Shin-Ru ^{[5
]}

Chang, Ching-Fen ^{[1
]}

Lin, Tzou-Yien ^{[2
]}

Huang, Yhu-Chering ^{[2
]}

Chang, Shih-Chen ^{[5
]}

Liu, Ming-Tsan ^{[6
]}

Ko, Yu-Shien ^{[3
,4
]}

Deng, Ming-Chung ^{[7
]}

Liau, Yea-Ling ^{[8
]}

Lin, Lung-Huang ^{[9
]}

Chen, Tou-Hwei ^{[9
]}

Yang, Chih-Hsun ^{[1
]}

Ho, Hsin-Chun ^{[1
]}

Lin, Jheng-Wei ^{[1
]}

Lu, Chun-Wei ^{[1
]}

Lu, Chin-Fang ^{[8
]}

Hung, Shuen-Iu ^{[10
]}

机构：

[1] Chang Gung Univ, Coll Med, Drug Hypersensit Clin & Res Ctr, Dept Dermatol,Chang Gung Mem Hosp, Taipei, Taiwan

[2] Chang Gung Univ, Coll Med, Chang Gung Mem Hosp, Dept Pediat, Taipei, Taiwan

[3] Chang Gung Univ, Coll Med, Chang Gung Mem Hosp, Cardiovasc Div 1, Taipei, Taiwan

[4] Linko Med Ctr, Taipei, Taiwan

[5] Chang Gung Univ, Res Ctr Emerging Viral Infect, Taipei, Taiwan

[6] Ctr Dis Control, Res & Diagnost Ctr, Taipei, Taiwan

[7] Div Hog Cholera Res, New Taipei City, Taiwan

[8] Chung Shan Hosp, Res Ctr Cutaneous Disorders, Dept Dermatol, Taipei, Taiwan

[9] Fu Jen Catholic Univ, Cathay Gen Hosp, Dept Pediat, Sch Med, Taipei, Taiwan

[10] Natl Yang Ming Univ, VYM Genome Res Ctr, Sch Med, Inst Pharmacol,Infect & Immun Res Ctr, Taipei 11221, Taiwan

来源：

JOURNAL OF INFECTIOUS DISEASES | 2013年 / 208卷 / 12期

关键词：

coxsackievirus A6; hand-foot-mouth disease; severe cutaneous adverse reactions; granulysin; TOXIC EPIDERMAL NECROLYSIS; STEVENS-JOHNSON-SYNDROME; REAL-TIME PCR; MOUTH-DISEASE; MULTIFORME MAJUS; VIRUS; HAND; FOOT; ENTEROVIRUS-71; HERPANGINA;

D O I：

10.1093/infdis/jit383

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. The cutaneous manifestations of human enterovirus (HEV) infection are usually limited, such as hand-foot-mouth disease. By comparison, Stevens-Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction (SCAR), mainly caused by drugs. During the HEV outbreaks in 2010-2012 in Taiwan, we identified 21 patients who developed widespread blistering mucocutaneous reactions without any suspected drug causality. Methods. We screened possible pathogen(s) for detecting human herpes virus (HHV1-HHV7), HEV, or Mycoplasma pneumoniae infections using throat swab virus cultures, real-time PCR, DNA sequencing, immunochemistry and electron microscopy analyses. Results. Coxsackievirus A6 (CVA6) DNA was identified in the blistering skin lesions in 6 of 21 patients. Cytotoxic T lymphocytes and natural killer cells expressing granulysin predominantly infiltrated into the skin lesions, sharing the histopathological features with SJS. Intact CVA6 viral particles were identified in the blister fluids and skin lesions by electron microscopy. The phylogenetic analysis of the viral genome showed the CVA6 DNA sequence sharing higher similarity (97.6%-98.1%) to CVA6 strains reported from Finland at 2008. Conclusions. This study identifies a new variant of CVA6 as the causative agent for severe mucocutaneous blistering reactions mimicking SCAR. An awareness of this unusual presentation of HEV infection is needed in the epidemic area.

引用

页码：1968 / 1978

页数：11

共 36 条

[1] Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis - Results of an international prospective study [J].