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Hattori N, Yamamoto K, Kawaguchi Y, Fujiwara S, Arai N, Kabasawa N, Tsukamoto H, Uto Y, Yanagisawa K, Saito B, Nakamaki T. Early relapse of severe chronic active Epstein-Barr virus infection with posterior reversible encephalopathy syndrome after reduced intensity stem cell transplantation with umbilical cord blood. Leuk Lymphoma 2016; 57:2448-51. [PMID: 26879589 DOI: 10.3109/10428194.2016.1142081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Norimichi Hattori
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Kohei Yamamoto
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Yukiko Kawaguchi
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Shun Fujiwara
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Nana Arai
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Nobuyuki Kabasawa
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Hiroyuki Tsukamoto
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Yui Uto
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Kouji Yanagisawa
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Bungo Saito
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
| | - Tsuyoshi Nakamaki
- a Division of Hematology, Department of Medicine , School of Medicine, Showa University , Shinagawa-Ku , Tokyo , Japan
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Watanabe S, Okada M, Tokugawa T, Sawada A, Ogawa H, Yoshikawa H. [Recurrence of chronic active Epstein-Barr virus infection presenting with myelopathy after umbilical cord blood transplantation]. Rinsho Shinkeigaku 2014; 54:809-13. [PMID: 25342015 DOI: 10.5692/clinicalneurol.54.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 38-year-old man was admitted to our hospital with neck pain, dysesthesia of both hands, and weakness of the left upper limb. He had been diagnosed with a chronic active Epstein-Barr virus infection (CAEBV) at the age of 34 and had undergone umbilical cord blood transplantation at the age of 37. MRI of the spinal cord revealed an intramedullary hyperintense lesion on T₂-weighted images with gadolinium enhancement. Because his laboratory tests revealed proliferation of CD19(+) lymphocytes in the peripheral blood, and EBV DNA was detected in both peripheral blood and CSF, he was diagnosed as having post-transplant EBV associated lymphoproliferative disease. However, chemotherapy did not alleviate his symptoms. At a later time, quantitative chimerism analysis of his CSF showed a higher proportion of lymphocytes that had originated from the recipient. Finally, he was diagnosed as having a recurrence of CAEBV in the central nervous system, and his symptoms were restored by intrathecal chemotherapy (methotrexate, cytosine arabinoside, and prednisolone). Quantitative chimerism analysis of CSF was useful for diagnosing the recurrence of CAEBV in the central nervous system.
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Affiliation(s)
- Shohei Watanabe
- Department of Internal Medicine, Division of Neurology, Hyogo College of Medicine
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Nomura Y, Kimura H, Karube K, Yoshida S, Sugita Y, Niino D, Shimizu K, Kimura Y, Aoki R, Kiyasu J, Takeuchi M, Hashikawa K, Hirose S, Ohshima K. Hepatocellular apoptosis associated with cytotoxic T/natural killer-cell infiltration in chronic active EBV infection. Pathol Int 2009; 59:438-42. [PMID: 19563406 DOI: 10.1111/j.1440-1827.2009.02391.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to identify the mechanism of hepatocellular apoptosis induced by EBV-infected cytotoxic T/natural killer (NK) cells in chronic active EBV infection (CAEBV). Eight patients with CAEBV were studied, and infected T-cell expansion and NK-cell expansion were detected in four patients each. Biopsy or necropsy was performed on lymph node, liver, or spleen, and each specimen was subjected to immunohistochemical double staining of CD3 plus caspase-3 with the addition of cytotoxic markers of T-cell restricted intracellular antigen-1 (TIA-1), perforin, and granzyme B, as well as EBV in situ hybridization (EBV-ISH). In the liver, some of the infiltrating CD3-positive lymphocytes stained positively for EBV-ISH and cytotoxic markers. Double staining of CD3 plus caspase-3 indicated caspase-3 positive hepatocytes with apoptotic features, accompanied by extensive infiltration of CD3-positive cells, which were directly attached to the apoptotic caspase-3 positive hepatocytes. In contrast, far fewer cells stained positive for caspase-3 in lymph node and spleen than in liver. The present findings suggest that in patients with CAEBV, cytotoxic T/NK cells may directly induce hepatocytes to undergo apoptosis more frequently than they do cells in other organs of the reticulo-endothelial system.
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Affiliation(s)
- Yuko Nomura
- Department of Pathology, School of Medicine, Kurume University, Kurume, Japan.
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Kobayashi Z, Tsuchiya K, Takahashi M, Yokota O, Sasaki A, Bhunchet E, Arai T, Akiyama H, Kamoshita M, Kotera M, Mizusawa H. An autopsy case of chronic active Epstein-Barr virus infection (CAEBV): distribution of central nervous system (CNS) lesions. J Neurol Sci 2008; 275:170-7. [PMID: 18793782 DOI: 10.1016/j.jns.2008.07.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 07/23/2008] [Accepted: 07/31/2008] [Indexed: 11/16/2022]
Abstract
A 27-year-old Japanese man developed recurrent respiratory and central nervous system (CNS) symptoms, and hemophagocytic syndromes with a clinical course of 6 years. CT demonstrated multiple nodular lesions in the bilateral lungs, and MRI revealed multiple abnormal intensity areas in the brain and spinal cord. Cerebrospinal fluid (CSF) examination disclosed mild pleocytosis and the presence of Epstein-Barr virus (EBV)-DNA detected by polymerase chain reaction (PCR). The patient died of a hemorrhagic shock associated with a hemophagocytic syndrome. A postmortem study revealed massive hemorrhage in the abdominal cavity and iliopsoas muscles, as well as diffuse infiltration of lymphocytes and/or macrophages into the lungs, liver, kidneys, spleen, cardiac muscle, bone marrow, and CNS. The severe involvement was demonstrated in the CNS, especially in the spinal cord and brainstem. The CD3 positive cells of the brainstem were EBV-encoded RNA 1 positive. This is the first autopsy case of chronic active EBV infection (CAEBV) in which severe and extensive CNS involvement was demonstrated.
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Affiliation(s)
- Zen Kobayashi
- Department of Neurology, Tsuchiura Kyodo Hospital, Ibaraki, 300-0053, Japan.
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