Journal of Clinical Virology 37 (2006) 222–226 Case report Cutaneous disseminated endemic Kaposi’s sarcoma in a Polynesian man infected with a new divergent human herpesvirus 8 subtype D Renan Duprez a , Olivier Cassar a,b , Oumkaltoum Hbid a,c , Yannick Rougier b , Laurent Morisse d , Sylviane Bassot a , Michel Huerre c , Antoine Gessain a,∗ a Unit´ e d’Epid´ emiologie et Physiopathologie des Virus Oncog` enes, Institut Pasteur, Paris, France b Institut Pasteur de Nouvelle-Cal´ edonie, Noum´ ea, Nouvelle-Cal´ edonie, France c Unit´ e de Recherche et d’Expertise en Histotechnologie et Pathologie, Institut Pasteur, Paris, France d Hˆ opital de Sia, Wallis, Wallis et Futuna, France Received 10 April 2006; received in revised form 22 June 2006; accepted 8 July 2006 Keywords: HHV-8; D subtype; Kaposi’s sarcoma; Polynesia; Wallis Island 1. Introduction Human herpesvirus 8 (HHV-8), also known as Kaposi’s sarcoma (KS)-associated herpesvirus (KSHV), is the etio- logical agent of all forms of Kaposi’s sarcoma, a tumor of mixed cellularity occurring frequently during human immun- odeficiency virus type 1 (HIV-1) infection (AIDS/epidemic- KS) and in transplant recipients (iatrogenic KS) (Boshoff and Weiss, 2001; Hengge et al., 2002). Such tumor also occurs among non-HIV-infected individuals, predominantly either in aged men of Mediterranean and Middle East ori- gins (classic KS) or in inhabitants from East and Central Africa (endemic KS) (Boshoff and Weiss, 2001; Hengge et al., 2002). Clinically, KS is mainly characterized by skin lesions of various aspects including macules, papules and/or nodules, which are mainly localized on the lower limbs in the classic form. However, disseminated skin lesions, with lymph-node Abbreviations: HHV-8, human herpesvirus 8; KSHV, Kaposi’s sarcoma associated herpesvirus; KS, Kaposi’s sarcoma; HIV, human immunodefi- ciency virus; WBC, white blood cells; HTLV, human T-lymphotropic virus; HE, haematoxylin–eosin; PCNA, proliferation cell nuclear antigen; LNA, latency nuclear antigen; IFA, immuno-fluorescent assay; DNA, deoxyribo- nucleic acid; PCR, polymerase chain reaction; ORF, open reading frame ∗ Corresponding author at: Unit´ e d’Epid´ emiologie et Physiopathologie des Virus Oncog` enes, D´ epartement de Virologie, Batiment Lwoff, Institut Pasteur, 25–28 rue du Dr. Roux, 75724 Paris Cedex 15, France. Tel.: +33 1 45 68 89 37; fax: +33 1 40 61 34 65. E-mail address: agessain@pasteur.fr (A. Gessain). involvement and visceral localizations (lungs and gastroin- testinal tract) are frequent in the HIV-associated form, as well as in some severe endemic KS cases (Boshoff and Weiss, 2001; Hengge et al., 2002). Epidemiological surveys indicate that HHV-8 is not a widespread ubiquitous virus. Its presence is mainly restricted to areas where classic or endemic KS are highly endemic, in which HHV-8 seroprevalence ranges from 5% to more than 50% of the general population (Dukers and Rezza, 2003). Molecular epidemiological studies exploiting the high genetic variability of K1 gene led to the identification of five major K1 subtypes (called A–E), some of which appear to be strongly linked to the geographical origin of the samples (Kazanji et al., 2005; Meng et al., 2001, 1999; Whitby et al., 2004; Zong et al., 2002). Thus, HHV-8 B strains predominate in Africa and are phylogenetically more distant from subtypes A and C (which are found mainly in Europe and the USA) than A and C are from each other. The few reported subtype E strains are restricted to populations of ancient American heritage as Amerindians (Kazanji et al., 2005; Whitby et al., 2004; Zong et al., 2002). Very few data are available on HHV-8 and associated dis- eases, especially Kaposi’s sarcoma in populations of ancient Pacific heritage including both Melanesians or Polynesians (Meng et al., 2001, 1999; Rezza et al., 2001; Sengupta et al., 1986; Zong et al., 2002). Here, we described a case of cutaneous disseminated KS, occurring in an elderly Polynesian man, who was infected by a divergent molecular variant of HHV-8 subtype D strain. 1386-6532/$ – see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2006.07.013