JC virus infection in allograft kidneys: analysis by polymerase chain reaction and immunohistochemistry.

BACKGROUND: Polyoma virus nephropathy after transplantation is believed to be primarily due to the BK virus. We hypothesized that some cases may be associated with the JC polyoma virus (JCV), which is also known to be latent in the kidney. METHODS: We sought polymerase chain reaction evidence of JCV infection in needle biopsy specimens with and without viral nephropathy. Cases positive by polymerase chain reaction were studied by immunohistochemistry for VP-1 antigen expression. RESULTS: JCV DNA was found in 7 (36.8%) of 19 allograft kidney biopsy specimens with viral nephropathy and 0 (0%) of 19 native or allograft biopsy specimens without viral nephropathy. Immunohistochemistry localized JCV to the nuclei of tubular epithelial cells in one case. CONCLUSIONS: JCV is detectable in a subset of renal allograft kidneys with polyoma virus nephropathy. The tubular epithelium is identified as a site capable of supporting JCV viral capsid protein VP-1 expression, and hence viral replication.

Metastasis of hepatocellular carcinoma to the right colon manifested by gastrointestinal bleeding.

An 82-year-old black woman with a history of hepatocellular carcinoma presented with gastrointestinal bleeding. Barium enema and fibrocolonoscopy revealed a 4-cm polypoid mass at the level of the ascending colon with evidence of active bleeding. Biopsies of the lesion proved it to be metastatic hepatocellular carcinoma. Exploratory laparotomy revealed no further dissemination of the tumor, and the patient underwent an ileocolectomy. The serosal side of the colonic lesion was free from tumor, and there was no peritoneal implantation, direct extension, or lymph node involvement. This case represents an extremely rare presentation of metastatic hepatocellular carcinoma.

Disseminated toxoplasmosis in the acquired immunodeficiency syndrome.

Fourteen cases of toxoplasmosis in subjects at autopsy with acquired immunodeficiency syndrome are reviewed. Death was related to toxoplasmosis in four cases: in three from central nervous system complications and in one case from myocarditis. In six cases the infection was identified outside of the central nervous system and in only two cases was infection disseminated to multiple extracerebral organs. Review of clinical history and laboratory data revealed no specific risk factors or laboratory indicators associated with toxoplasmosis in acquired immunodeficiency syndrome. Though inflammatory cell infiltrates often accompanied disseminated infections, diagnosis could be made with certainty only by finding characteristic Toxoplasma organisms, either as free tachyzoites, pseudocysts, or as true parasitic cysts. We found immunohistochemical staining to have limited usefulness for diagnosis in extracerebral sites. Characteristic Toxoplasma organisms were most readily identified in central nervous system tissues in our acquired immunodeficiency syndrome population, making this the most useful site for diagnosis.

A simple histochemical technique for the identification of gunshot residue.

Alizarin red S (ARS) is a commonly used organic dye useful in the histologic identification of calcium deposits. ARS also forms colored reaction products with other metal ions, including barium and lead, which are present in primer residue. In histochemical studies, ARS is shown to identify primer residues from several manufacturers as well as primer residue deposited in tissue, either experimentally or in close-range gunshot wounds. This can be easily accomplished with routine histologic techniques. ARS does not stain gunpowder residue, tattoo pigment, melanin, graphite, india ink, or anthracotic pigment.

Immune hemolytic anemia associated with biclonal cold autoagglutinins.

A 65-year-old man with bladder outlet obstruction due to prostatic hypertrophy was incidentally discovered to have cold-antibody autoimmune hemolytic anemia (cold-aggluthinin syndrome; CAS) due to autoanti-I (titer 1,024 at 4 degrees C and 64 at 30 degrees C), and a biclonal gammopathy. Immunofixation electrophoresis of serum and a red blood cell eluate revealed the patient's autoantibody to be biclonal IgM kappa and IgA kappa. No underlying cause could be determined to explain the development of either the biclonal gammopathy or the CAS. To our knowledge, this is the first reported case of CAS associated with a biclonal gammopathy and biclonal cold autoagglutinins of the IgM kappa, IgA kappa type.