Epstein-Barr virus-positive aggressive lymphoma as a consequence of immunosuppression after multiple salvage treatments for follicular lymphoma.
We report on a patient with follicular non-Hodgkin's lymphoma (NHL) who developed a fatal high-grade Epstein-Barr virus (EBV)-positive NHL after conventional chemotherapies. The sudden onset of the high-grade lymphoma was accompanied by increasing circulating EBV genome copies and was complicated by spontaneous rupture of the spleen. Splenic tissue was diffusely infiltrated by large B cells. In situ hybridization for Epstein-Barr-encoded RNA (EBER) 1-2 was positive in 70% of cells, and molecular analysis revealed the presence of EBV DNA and a monoclonal IgH gene rearrangement. This case shows that the immunosuppression of multiple treatments may induce uncontrolled reactivation of a latent EBV infection, contributing to high-grade transformation in heavily treated lymphoma patients.
Orlandi
E
E
Institute of Haematology, University of Pavia, and Division of Haematology, Anatomic Pathology Service, and Viral Diagnostic Service, IRCCS Policlinico S. Matteo, Pavia, University of Pavia, Italy. eorlandi@smatteo.pv.it
Paulli
M
M
Viglio
A
A
Pagnucco
G
G
Riboni
R
R
Baldanti
F
F
Lazzarino
M
M
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis; D017809:Fatal Outcome; D015321:Gene Rearrangement; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007150:Immunohistochemistry; D016393:Lymphoma, B-Cell / Q000150:complications / Q000175:diagnosis / Q000821:virology*; D008224:Lymphoma, Follicular / Q000150:complications / Q000628:therapy*; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D012422:Rupture, Spontaneous; D013161:Splenic Rupture / Q000150:complications; D017735:Virus Latency
D004279:DNA, Viral; D007143:Immunoglobulin Heavy Chains; D012367:RNA, Viral