Skip to main content

Advertisement

SpringerLink
Log in

Infectious mononucleosis accompanied by clonal proliferation of EBV-infected cells and infection of CD8-positive cells

  • Case Report
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

A 22-year-old male was admitted for a sustained fever of 2 months, lymphadenopathy, and liver dysfunction. Anti-VCA-IgM antibody was positive, with elevated Epstein–Barr virus (EBV)-DNA load in the peripheral blood. Liver biopsy revealed infiltration of CD8-positive and EBV-positive cells. Most peripheral blood mononuclear cells (PBMCs) were also positive for CD8, and showed detectable levels of EBV-DNA. Monoclonal proliferation of EBV-infected cells was detected in the PBMCs by Southern blotting for EBV-terminal repeat (EBV-TR). Although EBV-positive T-cell lymphoproliferative disease (EBV-T-LPD) was suspected, the symptoms spontaneously resolved within 12 months. Anti-VCA-IgM antibody and the clonal band of EBV-TR were negative 1 year after the onset, while anti-EBNA antibody was positive. The final diagnosis was thus confirmed as infectious mononucleosis (IM). Our results indicate that EBV-infected CD8-positive cells and clonal proliferation of EBV-infected cells may be temporally detected in IM. EBV-T-LPDs should be carefully excluded in such cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Young KH, Zhang D, Malik JT, et al. Fulminant EBV-driven CD8 T-cell lymphoproliferative disorder following primary acute EBV infection: a unique spectrum of T-cell malignancy. Int J Clin Exp Pathol. 2008;1:185–97.

    PubMed Central  PubMed  Google Scholar 

  2. Leight ER, Sugden B. EBNA-1: a protein pivotal to latent infection by Epstein–Barr virus. Rev Med Virol. 2000;10:83–100.

    Article  CAS  PubMed  Google Scholar 

  3. Heslop HE. Biology and treatment of Epstein–Barr virus-associated non-Hodgkin lymphomas. Hematol Am Soc Hematol Educ Progr 2005:260–266.

  4. Quintanilla-Martinez L, Kimura H, Jaffe ES. EBV-positive T-cell lymphoproliferative disorders of childhood. World Health Organization Classification of Tumors Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press; 2008. p. 278–80.

    Google Scholar 

  5. Raab-Traub N, Flynn K. The structure of the termini of the Epstein–Barr virus as a marker of clonal cellular proliferation. Cell. 1986;47:883–9.

    Article  CAS  PubMed  Google Scholar 

  6. Sandberg Y, van Gastel-Mol EJ, Verhaaf B, et al. BIOMED-2 multiplex immunoglobulin/T-cell receptor polymerase chain reaction protocols can reliably replace Southern blot analysis in routine clonality diagnostics. J Mol Diagn. 2005;7:495–503.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Tokunaga M, Uemura Y, Tokudome T, et al. Epstein–Barr virus-infected T cells in infectious mononucleosis. Acta Pathol Jpn. 1993;43:146–7.

    CAS  PubMed  Google Scholar 

  8. Anagnostopoulos I, Hummel M, Kreschel C, et al. Morphology, immunophenotype, and distribution of latently and/or productively Epstein–Barr virus-infected cells in acute infectious mononucleosis: implications for the interindividual infection route of Epstein–Barr virus. Blood. 1995;85:744–50.

    CAS  PubMed  Google Scholar 

  9. He HL, Wang MC, Huang WT. Infectious mononucleosis mimicking malignant T-cell lymphoma in the nasopharynx: a case report and review of the literature. Int J Clin Exp Pathol. 2013;6:105–9.

    PubMed Central  PubMed  Google Scholar 

  10. Fischer E, Delibrias C, Kazatchkine MD. Expression of CR2 (the C3dg/EBV receptor, CD21) on normal human peripheral blood T lymphocytes. J Immunol. 1991;146:865–9.

    CAS  PubMed  Google Scholar 

  11. Tabiasco J, Vercellone A, Meggetto F, et al. Acquisition of viral receptor by NK cells through immunological synapse. J Immunol. 2003;170:5993–8.

    Article  CAS  PubMed  Google Scholar 

  12. Stinchcombe JC, Bossi G, Booth S, et al. The immunological synapse of CTL contains a secretory domain and membrane bridges. Immunity. 2001;15:751–61.

    Article  CAS  PubMed  Google Scholar 

  13. Hodges E, Krishna MT, Pickard C, et al. Diagnostic role of tests for T cell receptor (TCR) genes. J Clin Pathol. 2003;56:1–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Plumbley JA, Fan H, Eagan PA, et al. Lymphoid tissues from patients with infectious mononucleosis lack monoclonal B and T cells. J Mol Diagn. 2002;4:37–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Virelizier JL, Lenoir G, Griscelli C. Persistent Epstein–Barr virus infection in a child with hypergammaglobulinaemia and immunoblastic proliferation associated with a selective defect in immune interferon secretion. Lancet. 1978;2:231–4.

    Article  CAS  PubMed  Google Scholar 

  16. Jones JF, Shurin S, Abramowsky C, et al. T-cell lymphomas containing Epstein–Barr viral DNA in patients with chronic Epstein–Barr virus infections. N Engl J Med. 1988;318:733–41.

    Article  CAS  PubMed  Google Scholar 

  17. Arai A, Imadome K, Watanabe Y, et al. Clinical features of adult-onset chronic active Epstein–Barr virus infection: a retrospective analysis. Int J Hematol. 2011;93:602–9.

    Article  PubMed  Google Scholar 

  18. Kimura H, Ito Y, Kawabe S, et al. EBV-associated T/NK-cell lymphoproliferative diseases in nonimmunocompromised hosts: prospective analysis of 108 cases. Blood. 2012;119:673–86.

    Article  CAS  PubMed  Google Scholar 

  19. Arai A, Nogami A, Imadome KI, et al. Sequential monitoring of serum IL-6, TNF-α, and IFN-γ levels in a CAEBV patient treated by plasma exchange and immunochemotherapy. Int J Hematol. 2012;96:669–73.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8519, Japan

    Ayako Arai, Honami Komatsu & Osamu Miura

  2. Musashino Red Cross Hospital, Tokyo, Japan

    Takeshi Yamaguchi & Kaoru Nagata

  3. Department of Infectious Diseases, National Research Institute for Child Health and Development, Tokyo, Japan

    Ken-Ichi Imadome

  4. Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Morito Kurata

Authors
  1. Ayako Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Honami Komatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ken-Ichi Imadome
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Morito Kurata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaoru Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Osamu Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayako Arai.

About this article

Cite this article

Arai, A., Yamaguchi, T., Komatsu, H. et al. Infectious mononucleosis accompanied by clonal proliferation of EBV-infected cells and infection of CD8-positive cells. Int J Hematol 99, 671–675 (2014). https://doi.org/10.1007/s12185-014-1548-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-014-1548-4

Keywords

Search

Navigation