I am writing in reference to Case 1 of the Pathological Cases of the Month in the July issue of the Archives.1 The clinical and pathologic data in this infant support the diagnosis of sinus histiocytosis with massive lymphadenopathy, Rosai-Dorfman disease. Although the patient had serologic tests for a number of viruses, neither serologic testing for human herpesvirus 6 (HHV-6) nor examination of tissue for HHV-6 was performed. In a recent publication, Levine et al2 demonstrated the presence of detectable HHV-6 by in situ hybridization in seven of nine patient biopsy specimens examined. Tissue from one patient had detectable Epstein-Barr virus genome and another had no detectable HHV-6 or Epstein-Barr virus. Thus, in some instances, HHV-6, and occasionally Epstein-Barr virus and other viruses, may initiate sinus histiocytosis with massive lymphadenopathy. I also would suggest that the spectrum of pediatric disease caused by infection with Rochalimaea (Bartonella) henselae3
Barton LL. Sinus Histiocytosis With Massive Lymphadenopathy. Arch Pediatr Adolesc Med. 1995;149(3):340–341. doi:10.1001/archpedi.1995.02170150120025
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