[en] Pyogenic granuloma (PG) is a vascular endothelial growth factor (VEGF)-related neoangiogenic process. Minor trauma, chronic irritation, certain drugs and pregnancy may favor PG. Viral triggers have not been reported up to date. A 52-year-old woman with hairly-cell leukemia presented because of a3-month history of a giant pseudotumoral lesion on her left cheek. All prior antibacterial, antifungal and anti-inflammatory treatments had failed. Histology revealed PG with sparse and isolated epithelial cell aggregates. Immunohistochemistry (IHC) identified herpes simplex virus type-I (HSV-I) antigens in the nuclei and cytoplasm of normal-appearing as well as cytopathic epithelial cells, suggesting a chronic, low-productive HSV infection. No HSV-I signal was evidenced in the endothelial cells of the PG. Furthermore, IHC revealed VEGF in the HSV-I infected epithelial cells as well as within the PG endothelial cells. These results incited oral treatment with valaciclovir, and the PG promptly resolved after 2 weeks. These findings suggest that a chronic HSV-I infection might play and indirect, partial role in neoangiogenesis, presumably via HSV-I infection-related stimulation of keratinocytic VEGF production.
Disciplines :
Dermatology
Author, co-author :
EL HAYDERI, Lara ; Centre Hospitalier Universitaire de Liège - CHU > Dermatologie
Wauters O, Sabatiello M, Nikkels-Tassoudji N, Choffray A, Richert B, Piérard GE, Nikkels AF: Pyogenic granuloma (in French). Ann Dermatol Venereol 2010;137:238-242.
Kamal R, Dahiya P, Puri A: Oral pyogenic granuloma: various concepts of etiopathogenesis. J Oral Maxillofac Pathol 2012;16:79-82.
Godfraind C, Calicchio ML, Kozakewich H: Pyogenic granuloma, an impaired wound healing process, linked to vascular growth driven by FLT4 and the nitric oxide pathway. Mod Pathol 2013;26:247-255.
Nikkels AF, Delbecque K, Pierard GE, Wienkotter B, Schalasta G, Enders M: Distribution of varicella-zoster virus DNA and gene products in tissues of a first-trimester varicella-infected fetus. J Infect Dis 2005;191:540-545.
Bragado R, Bello E, Requena L, Renedo G, Texeiro E, Alvarez MV, Castilla MA, Caramelo C: Increased expression of vascular endothelial growth factor in pyogenic granulomas. Acta Derm Venereol 1999;79:422-425.
Yuan K, Jin YT, Lin MT: The detection and comparison of angiogenesis-associated factors in pyogenic granuloma by immunohistochemistry. J Periodontol 2000;71:701-709.
Sakakibara S, Tosato G: Regulation of angiogenesis in malignancies associated with Epstein-Barr virus and Kaposi's sarcoma-associated herpes virus. Future Microbiol 2009;4:903-917.
Mulik S, Xu J, Reddy PB, et al: Role of miR-132 in angiogenesis after ocular infection with herpes simplex virus. Am J Pathol 2012;181:525-534.
Hayashi K, Hooper LC, Detrick B, Hooks JJ: HSV immune complex (HSV-IgG: IC) and HSV-DNA elicit the production of angiogenic factor VEGF and MMP-9. Arch Virol 2009;154:219-226.
Nikkels AF, Sadzot-Delvaux C, Rentier B, Piérard-Franchimont C, Piérard GE: Low-productive alpha-herpesviridae infection in chronic lichenoid dermatoses. Dermatology 1998;196:442-446.
Nikkels AF, Debrus S, Delvenne P, Sadzot-Delvaux C, Piette J, Rentier B, Piérard GE: Viral glycoproteins in herpesviridae granulomas. Am J Dermatopathol 1994;16:588-592.
Johnson KE, Wilgus TA: Multiple roles for VEGF in non-melanoma skin cancer: angiogenesis and beyond. J Skin Cancer 2012;2012:483439.
Wauters O, Lebas E, Nikkels AF: Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections. J Am Acad Dermatol 2012;66:e217-e227.
Modiano P, Salloum E, Gillet-Terver MN, et al: Acyclovir-resistant chronic cutaneous herpes simplex in Wiskott-Aldrich syndrome. Br J Dermatol 1995;133:475-478.
Böer A, Herder N, Winter K, Falk T: Herpes folliculitis: clinical, histopathological, and molecular pathologic observations. Br J Dermatol 2006;154:743-746.
