Aplastic Anemia with Epstein-Barr Virus Reactivation after Anti-thymocyte Globulin Therapy

Yo Kawarada; Ryujiro Hara; Toshihiko Kitahara; Hiroki Numata; Shigeki Watanabe; Masatoshi Yamada; Kiyoshi Ando

doi:10.2169/internalmedicine.0539-22

CASE REPORTS

Aplastic Anemia with Epstein-Barr Virus Reactivation after Anti-thymocyte Globulin Therapy

Yo Kawarada, Ryujiro Hara, Toshihiko Kitahara, Hiroki Numata, Shigeki Watanabe, Masatoshi Yamada, Kiyoshi Ando

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Keywords: aplastic anemia, infectious mononucleosis-like syndrome, anti-thymocyte globulin, lymphoproliferative disorders, Epstein-Barr virus

JOURNAL OPEN ACCESS

2023 Volume 62 Issue 17 Pages 2553-2557

DOI https://doi.org/10.2169/internalmedicine.0539-22

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Abstract

Lymphoproliferative disorders and Epstein-Barr virus reactivation (EBV-LPDs) have various forms of onset, ranging from infectious mononucleosis-like syndrome (IM-like) to lymphoma, although whether or not IM-like progresses to lymphoma remains unclear. A 61-year-old man was diagnosed with aplastic anemia (AA). Polyclonal atypical B-lymphocytes were observed in the peripheral blood, and IM-like was diagnosed. Atypical lymphocytes disappeared, but a gastrointestinal examination revealed diffuse large B-cell lymphoma (DLBCL). Rituximab was initiated but later discontinued because of severe acute respiratory syndrome coronavirus 2 infection. Pancytopenia due to AA exacerbation recurred. The patient ultimately died of multiple organ failure due to bacterial infection.

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