Polyomavirus Sinusitis.
Helena N Spartz, Leticia Miravalle, Stephen D Allen. Indiana University, Indianapolis
Background: Viral diseases are a significant source of morbidity and mortality, particularly in immunosuppressed individuals. The well-characterized human polyomaviruses, BK and JC virus, have long been known to cause serious illness in immunosuppressed patients including nephropathy, hemorrhagic cystitis, and progressive multifocal leukoencephalopathy. More recently, three additional polyomaviruses have been found to naturally infect humans; KI, WU, and MC viruses. Polyomaviruses are thought to be transmitted via a respiratory route at an early age resulting in subclinical or mild respiratory illness. The viruses subsequently establish latent, asymptomatic infections in various tissues in immunocompetent patients. Immunosuppression allows reactivation from a subclinical state to lytic infection and severe or fatal disease. The recently described KI and WU viruses have been associated with respiratory infection in immunocompetent and immunosuppressed children and adults. However, their role in respiratory disease remains unclear.
Design: In this study, we examined sinus mucosa from a 57 year old patient with a long-standing history of CLL/SLL and known secondary immunosuppression, including a history of CMV colitis. The patient presented with massive periorbital edema, fever, and sharp pain over the sinuses. A CT of the sinuses showed nearly complete opacification of the maxillary, sphenoid, and frontal sinuses. Endoscopic sinus surgery was performed.
Results: Routine H&E sections revealed numerous sinus epithelial nuclei distended with pale, eosinophilic, homogenous inclusions and marginated chromatin. Immunohistochemical studies were negative for EBV, Herpes 1 and 2, Adenovirus, and CMV. No bacterial, fungal, or acid-fast microorganisms were detected. Immunohistochemistry using the anti-SV40 monoclonal antibody (MRQ-4, Cell Marque, Rocklin, CA) directed against the SV40 polyomavirus large T antigen demonstrated intense positive staining of the nuclear inclusions. Electron microscopy of the nuclear inclusions revealed abundant, densely packed, uniform, unencapsulated viral particles measuring approximately 35 nm.
Conclusions: The current study demonstrates the first reported case of sinusitis with polyomavirus infection. The case supports the proposed route of polyomavirus infection and demonstrates a possible role for polyomaviruses in upper respiratory infections in immunosuppressed patients. Additional studies are underway to further identify and sequence the virus.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 232, Wednesday Afternoon