Epstein-Barr virus-related primary cutaneous amyloidosis. Successful treatment with acyclovir & interferon-alpha

Cutaneous lesions related to chronic active Epstein-Barr virus (EBV)

infection have been rarely documented in immunocompetent

patients. A 30-year-old woman, fulfilling the diagnostic

criteria for the chronic fatigue syndrome, had a 10-year

history of pruritic brownish macules and papules on her chest

and back. Her EBV serology was abnormal; the EBV genome was

present in the epidermis of lesions, in oral secretions, and

in peripheral mononuclear cells (PMC). Her blood lymphocytes

spontaneously outgrew in culture. Histology revealed deposits

of amyloid in the papillary dermis. Treatment with acyclovir

and interferon-alpha rapidly improved her condition, stopped

the lymphocyte outgrowth in culture, and reduced the EBV DNA

content in oral secretions and in PMC. These data support an

endogenous reactivation of EBV infection and suggest a causal

relationship with primary amyloidosis.

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