Clinicopathologic Features of Varicella Zoster Virus Infection of the Upper Gastrointestinal Tract.

TitleClinicopathologic Features of Varicella Zoster Virus Infection of the Upper Gastrointestinal Tract.
Publication TypeJournal Article
Year of Publication2021
AuthorsMostyka M, Shia J, Neumann WL, Whitney-Miller CL, Feely M, Yantiss RK
JournalAm J Surg Pathol
Volume45
Issue2
Pagination209-214
Date Published2021 02 01
ISSN1532-0979
KeywordsAdult, Aged, Aged, 80 and over, Female, Herpes Zoster, Humans, Immunocompromised Host, Male, Middle Aged, Upper Gastrointestinal Tract
Abstract

Reactivation of latent varicella zoster virus (VZV) may be limited to a dermatome or involve multiple organs, including the gastrointestinal tract. Although gastrointestinal manifestations of disseminated zoster have been likened to those of herpes simplex virus (HSV), histologic features of VZV-related injury to the tubular gut are not well-documented. We performed this study to describe the clinicopathologic features of VZV-related gastrointestinal injury. We identified 6 such patients with VZV infection. All involved the upper gastrointestinal tract, affecting the esophagus (n=3), stomach (n=2), or both (n=1). All patients were immunocompromised adults with hematologic malignancies (n=5) or a heart transplant (n=1); 3 with hematologic malignancies had received stem cell transplants. Five patients had cutaneous and gastrointestinal zoster; 1 had gastrointestinal disease alone. When compared with 14 HSV-related esophagitis controls, there were several notable differences. VZV caused hemorrhagic ulcers with nodularity or erythema, whereas HSV produced round, shallow ulcers on a background of nearly normal mucosa (P=0.01). VZV-related ulcers featured fibrin-rich, pauci-inflammatory exudates compared with the macrophage-rich exudates of HSV (P=0.003). The cytopathic changes of VZV were present at all levels of the squamous epithelium, especially in a peripapillary distribution. In contrast, HSV inclusions were located in the superficial layers (P=0.003) and detached keratinocytes. Unlike HSV, VZV involved the stomach, producing hemorrhage accompanied by striking apoptosis in the deep glands. We conclude that VZV produces unique patterns of gastrointestinal injury that facilitate its diagnosis. Recognition of gastrointestinal VZV infection is important because it heralds potentially life-threatening disseminated disease.

DOI10.1097/PAS.0000000000001576
Alternate JournalAm J Surg Pathol
PubMed ID32826528
Related Faculty: 
Rhonda K. Yantiss, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
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