Herpes simplex Hepatitis and Hairy Cell Leukemia in an Allograft Liver
Patchy confluent necrosis and inflammation
Sinusoidal mononuclear cells
The biopsy showed multifocal coagulative necrosis and an immunostain for Herpes simplex virus types I and II was positive, consistent with acute Herpesvirus hepatitis. In addition, increased numbers of sinusoidal and aggregated mononuclear cells were seen and immunostains revealed these to be of B cell type. A bone marrow biopsy was performed and the cells were BRAF positive with weak uptake of Annexin A1. Flow cytometry showed CD20 (bright), CD11c, CD305/LAIR, CD253 and CD103 positivity with negativity for CD123. Molecular studies showed BRAF V600E mutation, consistent with hairy cell leukemia.
Hairy cell leukemia is currently not considered to be within the categories of PTLD and has been reported only rarely in organ transplant recipients. Tsao et al. reported one case in a heart transplant patient and Mamzer-Bruneel et al. reported this occurrence in a renal transplant recipient.
We are not exactly aware of when the transplant was performed, only that it was "several years" prior. The possibility that the leukemia represented a donor-transmitted disease might also have to be considered in this patient.