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Delaye M, Ricard L, Maisonobe L, Chartier S, Coppo P. Cytomegalovirus lymphadenitis mimicking a relapsed diffuse large B-cell lymphoma. Clin Case Rep 2022; 10:e6611. [PMID: 36583199 PMCID: PMC9792642 DOI: 10.1002/ccr3.6611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/04/2022] [Accepted: 10/30/2022] [Indexed: 12/28/2022] Open
Abstract
Cytomegalovirus (CMV) reactivation is frequent after autologous stem cell transplantation (ASCT), but generalized CMV lymphadenitis is rare. We report a CMV lymphadenitis after an ASCT mimicking a relapse of a diffuse large B-cell lymphoma. After histopathological documentation, CMV lymphadenitis should be treated to avoid systemic progression.
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Affiliation(s)
- Matthieu Delaye
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint‐Antoine, AP‐HPSorbonne UniversityParisFrance
| | - Laure Ricard
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint‐Antoine, AP‐HPSorbonne UniversityParisFrance
| | - Lucas Maisonobe
- Infectious Diseases Department, Hôpital Saint‐AntoineGroupe Hospitalier Sorbonne Université, APHPParisFrance
| | | | - Paul Coppo
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint‐Antoine, AP‐HPSorbonne UniversityParisFrance
- Reference Center for Thrombotic Microangiopathies (CNR‐MAT), AP‐HPParisFrance
- INSERM UMRS1138Centre de Recherche des CordeliersParisFrance
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Yu SC, Ko KY, Teng SC, Huang TC, Lo HT, Cheng CL, Yao M, Hong RL, Chen CN, Chen TC, Yang TL. A Clinicopathological Study of Cytomegalovirus Lymphadenitis and Tonsillitis and Their Association with Epstein-Barr Virus. Infect Dis Ther 2021; 10:2661-2675. [PMID: 34623624 PMCID: PMC8572917 DOI: 10.1007/s40121-021-00528-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Histopathological characteristics of cytomegalovirus (CMV) lymphadenitis have been well described. Rare studies have reported the immune status and clinical features. Clinically, experts believed that CMV lymphadenitis develops in immunocompromised and immunocompetent patients. Infectious mononucleosis (IM)-like syndrome is the most well-known clinical presentation. Methods We reviewed archived CMV immunohistochemical stains on lymphoid tissues. The clinicopathological features of CMV-positive cases were studied. Results For lymph nodes, we detected CMV in 29% (5/17) allogeneic peripheral blood hematopoietic stem cell transplantation (PBSCT) recipients, 29% (4/14) post-autologous PBSCT patients, 13% (6/47) patients treated with intravenous chemotherapy, and 9% (9/96) immunocompetent patients. We detected CMV in 7% (2/24) of tonsils but not in the nasopharynx, tongue base, or spleen specimens. The patients with iatrogenic immunodeficiency ranged from 37 to 76 years old. CMV infections developed a few years after lymphoma treatment (median duration after allogeneic PBSCT, 932 days; after autologous PBSCT, 370 days; and after chemotherapy, 626 days). The most common clinical presentation was neck mass (13/25, 42%), followed by asymptomatic image finding (10/25, 40%). Positron emission tomography/computed tomography (PET/CT) scan showed increased uptake compared to the liver in all patients (11/11, 100%). Of 10 lymphoma patients, 8 (80%) had a Deauville score of 4–5; they accounted for 30% (8/27) of lymphoma patients with false-positive PET/CT scan results. All cases were self-limiting. 96% (23/25) cases had Epstein–Barr virus coinfection, and EBER-positive cells were predominantly in a few germinal centers. Conclusions Cytomegalovirus (CMV) lymphadenitis and tonsillitis were subclinical infections, not primary CMV infection with IM-like syndrome. The lymphadenopathy typically developed a few years after lymphoma treatments in the middle-aged and the elderly. The lesions mimicked lymphoma relapse in PET scans. Therefore, recognizing CMV infection in lymphoid tissues is of clinical importance. Graphic abstract ![]()
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Affiliation(s)
- Shan-Chi Yu
- Graduate Institute of Microbiology, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren-Ai Road, Taipei, 100, Taiwan. .,Department of Pathology and Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pathology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Kuan-Yin Ko
- Department of Nuclear Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Chun Teng
- Graduate Institute of Microbiology, College of Medicine, National Taiwan University, No. 1, Sec. 1, Ren-Ai Road, Taipei, 100, Taiwan.
| | - Tai-Chung Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Ting Lo
- Department of Pathology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chieh-Lung Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming Yao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruey-Long Hong
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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