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J Infect Dis. Clinicopathologic Analysis of Coxsackievirus A6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions
[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]
Clinicopathologic Analysis of Coxsackievirus A6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions
Wen-**** Chung 1,a, Shin-Ru Shih 2,a, Ching-Fen Chang 1, Tzou-Yien Lin 3, Yhu-Chering Huang 3, Shih-Chen Chang 2, Ming-Tsan Liu 4, Yu-Shien Ko 5, Ming-Chung Deng 6, Yea-Ling Liau 7, Lung-Huang Lin 8, Tou-Hwei Chen 8, Chih-Hsun Yang 1, Hsin-Chun Ho 1, Jheng-Wei Lin 1, Chun-Wei Lu 1, Chin-Fang Lu 7 and Shuen-Iu **** 9
Author Affiliations: <SUP>1</SUP>Department of Dermatology, Drug hypersensitivity clinic and research center <SUP>2</SUP>Research Center for Emerging Viral Infections, Chang Gung University <SUP>3</SUP>Department of Pediatrics <SUP>4</SUP>Research & Diagnostic Center, Centers for Disease Control, Taiwan, No. 161, Kun-yang Street, Taipei, 11561, Taiwan <SUP>5</SUP>First Cardiovascular Division, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Keelung, Taipei, and Linko, 199 Tung-Hwa North Road, Taipei 105, Taiwan <SUP>6</SUP>Division of Hog Cholera Research, 376 Zhong-Jheng Rd., DanShuei District, New Taipei city, 251, Taiwan <SUP>7</SUP>Department of Dermatology, Research Center of Cutaneous Disorders, Chung Shan Hospital, 11, Lane 112, Section 4, Jenai Road, Taipei 106, Taiwan <SUP>8</SUP>Department of Pediatrics, Cathay General Hospital, School of Medicine, Fu-Jen Catholic University, No.280 Section 4, Jenai Road, Taipei 106, Taiwan <SUP>9</SUP>Institute of Pharmacology, School of Medicine, Infection and Immunity Research Center, VYM Genome Research Center, National Yang-Ming University, 155 Section 2, Linong Street, Taipei 112, Taiwan
Correspondence: Shuen-Iu ****, PhD, Institute of Pharmacology, Infection and Immunity Research Center, National Yang-Ming University, 155, Linong St, Sec 2, Beitou, Taipei 11221, Taiwan. Telephone: +886-28267201; Fax: +886-2-28264372; E-mail: sihung@ym.edu.tw.
a W.-H. C. and S.-R. S. contributed equally to this study.
Abstract
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 to 2012 in Taiwan, we identified 21 patients 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.
Received February 21, 2013. Revision received May 21, 2013. Accepted May 23, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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Clinicopathologic Analysis of Coxsackievirus A6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions
Wen-**** Chung 1,a, Shin-Ru Shih 2,a, Ching-Fen Chang 1, Tzou-Yien Lin 3, Yhu-Chering Huang 3, Shih-Chen Chang 2, Ming-Tsan Liu 4, Yu-Shien Ko 5, Ming-Chung Deng 6, Yea-Ling Liau 7, Lung-Huang Lin 8, Tou-Hwei Chen 8, Chih-Hsun Yang 1, Hsin-Chun Ho 1, Jheng-Wei Lin 1, Chun-Wei Lu 1, Chin-Fang Lu 7 and Shuen-Iu **** 9
Author Affiliations: <SUP>1</SUP>Department of Dermatology, Drug hypersensitivity clinic and research center <SUP>2</SUP>Research Center for Emerging Viral Infections, Chang Gung University <SUP>3</SUP>Department of Pediatrics <SUP>4</SUP>Research & Diagnostic Center, Centers for Disease Control, Taiwan, No. 161, Kun-yang Street, Taipei, 11561, Taiwan <SUP>5</SUP>First Cardiovascular Division, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Keelung, Taipei, and Linko, 199 Tung-Hwa North Road, Taipei 105, Taiwan <SUP>6</SUP>Division of Hog Cholera Research, 376 Zhong-Jheng Rd., DanShuei District, New Taipei city, 251, Taiwan <SUP>7</SUP>Department of Dermatology, Research Center of Cutaneous Disorders, Chung Shan Hospital, 11, Lane 112, Section 4, Jenai Road, Taipei 106, Taiwan <SUP>8</SUP>Department of Pediatrics, Cathay General Hospital, School of Medicine, Fu-Jen Catholic University, No.280 Section 4, Jenai Road, Taipei 106, Taiwan <SUP>9</SUP>Institute of Pharmacology, School of Medicine, Infection and Immunity Research Center, VYM Genome Research Center, National Yang-Ming University, 155 Section 2, Linong Street, Taipei 112, Taiwan
Correspondence: Shuen-Iu ****, PhD, Institute of Pharmacology, Infection and Immunity Research Center, National Yang-Ming University, 155, Linong St, Sec 2, Beitou, Taipei 11221, Taiwan. Telephone: +886-28267201; Fax: +886-2-28264372; E-mail: sihung@ym.edu.tw.
a W.-H. C. and S.-R. S. contributed equally to this study.
Abstract
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 to 2012 in Taiwan, we identified 21 patients 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.
Received February 21, 2013. Revision received May 21, 2013. Accepted May 23, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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