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Yoshida N, Sugiyama G, Sugi S, Satake K, Wakasugi D, Yamasaki S, Mihara Y, Matsuda K, Ida H, Ohshima K, Yamaguchi R, Nakashima M. A case of acute diffuse large B cell lymphoma in an anti-human T-cell leukaemia virus type 1-positive rheumatoid arthritis patient treated with methotrexate, who died. Mod Rheumatol Case Rep 2019; 4:161-167. [PMID: 33087004 DOI: 10.1080/24725625.2019.1702493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 70-year-old woman was hospitalised due to jaundice and fever. She was diagnosed with rheumatoid arthritis (RA) at 54 years of age. Treatment with methotrexate (MTX) was successful, and her RA was in remission. Five weeks before the hospitalisation, she was diagnosed with optic neuritis due to a decline in the visual acuity of the right eye. She was treated with methylprednisolone pulse therapy, followed by prednisolone (PSL), before the hospitalisation, which were not effective. Blood tests showed increased C-reactive protein (CRP) levels, liver injury, and thrombocytopenia. Abdominal echo revealed numerous enlarged lymph nodes in the hepatic portal region. Malignant lymphoma was suspected due to high serum levels of soluble interleukin-2 receptor. None of the treatments were effective, and she died on the fifth hospital day. Diffuse large B cell lymphoma was diagnosed during the autopsy, which showed infiltration of CD20-positive atypical lymphocytes in almost all organs. Since she was taking MTX, she was diagnosed with immunosuppressive drug-associated lymphoproliferative disease (LPD). Anti-human T-cell leukaemia virus type 1 (HTLV-1) antibody was detected in her serum after her death; however, adult T cell leukaemia/lymphoma was not observed. LPD develops during the treatment of RA with disease modifying anti-rheumatic drugs; however, a rapid clinical course leading to death is rarely observed. Previous reports suggest that T cell dysregulation observed in HTLV-1 may contribute towards the development of B cell lymphoma. We have discussed the possible roles of HTLV-1 in LPD development in this case.
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Affiliation(s)
- Naomi Yoshida
- Division of Rheumatology, Kurume University Medical Center, Kurume, Japan
| | - Gen Sugiyama
- Division of Gastroenterology, Kurume University Medical Center, Kurume, Japan
| | - Suzuna Sugi
- Division of Rheumatology, Kurume University Medical Center, Kurume, Japan
| | - Koki Satake
- Division of Rheumatology, Kurume University Medical Center, Kurume, Japan
| | - Daisuke Wakasugi
- Division of Rheumatology, Kurume University Medical Center, Kurume, Japan
| | - Satoshi Yamasaki
- Division of Rheumatology, Kurume University Medical Center, Kurume, Japan
| | - Yutaro Mihara
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Kotaro Matsuda
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroaki Ida
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Rin Yamaguchi
- Division of Pathology, Kurume University Medical Center, Kurume, Japan
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Liu K, Zhou F, Fu Z, Yin J, Li W. Coexistence of T-cell lymphoblastic lymphoma and acute myeloid leukemia mimicking acute lymphocytic leukemia. INDIAN J PATHOL MICR 2018; 61:464-467. [PMID: 30004087 DOI: 10.4103/ijpm.ijpm_6_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Keyu Liu
- Department of Clinical Laboratory, Affiliated Hospital of Engineering University of Hebei, Hebei Province, China
| | - Fengling Zhou
- Department of Hematology, Affiliated Hospital of Engineering University of Hebei, Hebei Province, China
| | - Zexian Fu
- Department of Science and Education, Affiliated Hospital of Engineering University of Hebei, Hebei Province, China
| | - Junping Yin
- Department of Clinical Laboratory, Affiliated Hospital of Engineering University of Hebei, Hebei Province, China
| | - Wei Li
- Department of Obstetrics, Affiliated Hospital of Engineering University of Hebei, Hebei Province, China
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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. [PMID: 22983646 DOI: 10.1007/s12185-012-1170-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/27/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
We report the case of a female patient with chronic active Epstein-Barr virus infection (CAEBV) accompanied by hemophagocytic syndrome (HPS). On admission, she presented with severe liver dysfunction and disseminated intravascular coagulation with elevation of serum IL-6, TNF-α, and IFN-γ levels. Plasma exchange (PE) followed by immunochemotherapy with prednisolone, cyclosporine A, and VP16 was performed. PE decreased serum cytokine levels dramatically and improved liver function. Following immunochemotherapy, CAEBV became inactive. Four months after discharge, however, CAEBV relapsed with HPS, and serum cytokine levels were extremely elevated again. There was no response to immunochemotherapy, and the patient died 1 day after admission. We examined the cytokines in five additional untreated-CAEBV patients and determined that they were elevated above the normal level in all patients. These results suggest that inflammatory cytokines may have roles in the development of CAEBV, and that their depletion can be an effective treatment for this disease.
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Arai A, Imadome KI, Wang L, Wu N, Kurosu T, Wake A, Yamamoto H, Ota Y, Harigai M, Fujiwara S, Miura O. Recurrence of chronic active Epstein-Barr virus infection from donor cells after achieving complete response through allogeneic bone marrow transplantation. Intern Med 2012; 51:777-82. [PMID: 22466838 DOI: 10.2169/internalmedicine.51.6769] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 35-year-old woman with chronic active Epstein-Barr virus (EBV) infection (CAEBV). She underwent allogeneic bone marrow transplantation (BMT) from an unrelated male donor and achieved a complete response. However, her CAEBV relapsed one year after BMT. EBV-infected cells proliferated clonally and revealed a 46XY karyotype. In addition, the infecting EBV strain differed from that detected before BMT. These findings indicated that her disease had developed from donor cells. This is the first report of donor cell-derived CAEBV that recurred after transplantation, suggesting that host factors may be responsible for the development of this disease.
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MESH Headings
- Adult
- Base Sequence
- Bone Marrow Transplantation/adverse effects
- Chromosomes, Human, X/genetics
- Chromosomes, Human, Y/genetics
- Chronic Disease
- DNA, Viral/genetics
- Epstein-Barr Virus Infections/etiology
- Epstein-Barr Virus Infections/genetics
- Epstein-Barr Virus Infections/therapy
- Epstein-Barr Virus Infections/virology
- Female
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Lupus Erythematosus, Systemic/complications
- Lymphoproliferative Disorders/etiology
- Lymphoproliferative Disorders/genetics
- Lymphoproliferative Disorders/therapy
- Lymphoproliferative Disorders/virology
- Male
- Recurrence
- T-Lymphocytes/virology
- Tissue Donors
- Transplantation, Homologous
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Affiliation(s)
- Ayako Arai
- Department of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
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