[The understanding of Epstein-Barr virus associated lymphoproliferative disorder]

Natural killer/T-cell lymphoma with intracranial infiltration and Epstein-Barr virus infection: A case report

BACKGROUND

Because of atypical clinical symptoms, lymphoma is easily confused with infectious diseases. Extranodal nasal-type natural killer/T-cell lymphoma (NKTL) is more common, and there are few cases of eyelid site onset and intracranial infiltration, which increases the difficulty of diagnosis. This disease usually has a very poor prognosis and there are few reports of recovery.

CASE SUMMARY

A 3-year-old boy was admitted to our hospital due to an initial misdiagnosis of "eyelid cellulitis" and failed antibiotic treatment. He was characterized by fever, right eyeball bulging, convulsions, and abnormal liver function. His blood Epstein-Barr virus (EBV) DNA was positive (8.798 × 10⁴ copies/mL), and remained positive for about half a year. The cranial imaging examination suggested a space-occupying lesion in the right eyelid, with the right temporal lobe and meninges involved. The boy underwent ocular mass resection. The pathological diagnosis was NKTL. He was diagnosed as having NKTL with intracranial infiltration, combined with chronic active EBV infection (CAEBV). Then he underwent systemic chemotherapy and intrathecal injection. The boy suffered from abnormal blood coagulation, oral mucositis, diarrhea, liver damage, and severe bone marrow suppression but survived. Finally, the tumor was completely relieved and his blood EBV-DNA level turned negative. The current follow-up has been more than 2 years and his condition is stable.

CONCLUSION

This case suggests that chemotherapy combined with intrathecal injection may have a good effect on intracranial infiltrating lymphoma and CAEBV, which deserves further study and discussion.

Chronic active EBV infection associated with NK cell lymphoma and hemophagocytic lymphohistiocytosis in a 27-year-old woman: A case report

RATIONALE

Chronic active Epstein-Barr virus infection (CAEBV) is a common infectious disease that often affects multiple organs or systems. However, it is liable to be neglected and misdiagnosed owing to its insidious onset, lack of specific findings in the early phase, and a general lack of awareness among clinicians. PATIENT CONCERNS:: a 27-year-old woman case has been described who was initially misdiagnosed as drug-induced liver injury due to onset presentation of mild splenomegaly, recurrent liver dysfunction, and disputable pathological evidence of liver biopsy.

DIAGNOSES

CAEBV complicated with natural killer (NK) cell lymphoma and hemophagocytic lymphohistiocytosis (HLH) was diagnosed by in situ hybridization of liver tissue section with EBV-encoded RNA -1 probe and flow cytometry of bone marrow.

INTERVENTIONS

After admission, the patient received symptomatic treatment and antiviral therapy (combination of acyclovir and foscarnet sodium) as well as adjuvant treatment (thymosin alpha 1 and methylprednisolone); later, the patient received etoposide and dexamethasone for diagnosis of EBV associated HLH. Subsequently, the disease progressed to NK cell lymphoma and the patient received the revised EPOCH chemotherapy regimen [etoposide (100 mg/d, d1-5), dexamethasone (7.5 mg/d, d1-5; 5 mg/d, d6-14), cyclophosphamide (0.8 g/d, d1-2), and pegaspargase (3750 u/d, tid, d1-2)].

OUTCOMES

Although the patient received a series of therapies and other comprehensive measures, finally she died of gastrointestinal hemorrhage and multiple organ failure.

LESSONS

Liver is one of the main target organs of EBV infection. In the clinical setting of unexplained fever and liver injury, it is necessary to be aware of CAEBV, as well as its fatal complication such as EBV associated NK cell lymphoma and HLH.

Numb Chin as Signal for Malignancy-Primary Intraosseous Diffuse Large B-Cell Lymphoma of the Mandible

Malignant lymphomas are about 5% of all malignant tumors. Extranodal non-Hodgkin's lymphomas (NHLs) are found in 26% of these cases. Lymphomas of the head-and-neck area occur in 2%-3% of all malignancies, with 28% with an extranodal manifestation. Extranodal NHLs in the oral cavity are usually found in the maxilla, and rarely in the mandible. Their symptoms and clinical manifestation have no pathognomonic features; therefore, the expression of this uncommon entity can be diagnosed with an odontogenic inflammatory process, leading to a misdiagnosis. Delay in the decision for a biopsy, and adequate treatment for the patient directly impairs the prognosis of this neoplasm. This study reports a case of a patient with discomfort in the right mandible and paresthesia of the right lower lip and chin without any dental focus. After performing further diagnostic examinations including a subsequent biopsy, the final diagnosis was a diffuse large B-cell lymphoma (DLBCL). Intraosseous DLBCLs are uncommon in the daily clinical routine, but emphasize the need for careful examination by the clinicians also considering the differential diagnosis of sensory neuropathy. Neurological symptoms with no apparent cause should raise the suspicion of malignancy until the opposite is proven.