CASE REPORT

Pathology of astrovirus associated diarrhoea in a paediatric bone marrow transplant recipient

N J Sebire¹, M Malone¹, N Shah², G Anderson¹, H B Gaspar³ and W D Cubitt⁴

¹ Department of Histopathology, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
² Department of Gastroenterology, Great Ormond Street Hospital, Great Ormond Street, London
³ Department of Immunology, Great Ormond Street Hospital
⁴ Department of Virology, Great Ormond Street Hospital, Great Ormond Street

Correspondence to:
Correspondence to:
Dr N J Sebire
Department of Histopathology, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; SebirN{at}gosh.nhs.uk

Human astrovirus infection often causes outbreaks of self limiting diarrhoea, but may also infect patients who are immunodeficient or immunocompromised. Although there are previous publications relating to various aspects of astroviruses, there is a minimal amount of literature on the histopathological features of gastrointestinal astrovirus infection in humans. We report the histopathological findings, including immunohistochemical and electron microscopic features, of astrovirus infection in a bone marrow transplant recipient aged 4 years with diarrhoea. The appearance of a small intestinal biopsy did not suggest graft versus host disease, but demonstrated villous blunting, irregularity of surface epithelial cells, and an increase in lamina propria inflammatory cell density. Immunohistochemical staining with a murine astrovirus group specific monoclonal antibody demonstrated progressively more extensive staining in the duodenal and jejunal biopsies, predominantly restricted to the luminal surface and cytoplasm of surface epithelial cells, most marked at the villus tips. Electron microscopic examination demonstrated viral particles within the cytoplasm of enterocytes, focally forming paracrystalline arrays.

Abbreviations: GVHD, graft versus host disease

Keywords: astrovirus; bone marrow transplantation; immunohistochemistry; electron microscopy

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