Hepatitis E virus-induced primary cutaneous CD30(+) T cell lymphoproliferative disorder

Area of Science:

• Virology
• Immunology
• Dermatology

Background:

• Hepatitis E virus (HEV) infection is linked to unexplained extra-hepatic manifestations, including hematological disorders.
• The mechanisms behind these HEV-associated manifestations remain unclear.
• This study investigates HEV's potential extra-hepatic tropism and its role in cutaneous T cell lymphoproliferative disorders (T-LPD).

Observation:

• A patient with CD30(+) T-LPD and chronic HEV infection was treated with ribavirin.
• HEV was detected in dermal microvascular endothelial cells of the patient's skin lesions.
• T cell analysis revealed an oligoclonal CD8(+) T cell infiltrate with a tissue-resident memory phenotype.

Findings:

• Antiviral therapy resulted in remission of the T-LPD, which was sustained after achieving a virologic response.
• HEV exhibits extra-hepatic tropism, specifically infecting dermal endothelium.
• The infiltrating T cells showed a skewed Vβ signature and an oligoclonal profile, suggesting a clonal expansion driven by HEV.

Implications:

• HEV should be considered a potential cause of lymphoproliferative disorders, particularly T-LPD involving the skin.
• HEV's extra-hepatic endothelial tropism is a key factor in its pathogenesis of T-LPD.
• Antiviral treatment may be a viable first-line therapy for HEV-associated T-LPD, offering an alternative to chemotherapy.