title: Epstein-Barr virus associated diffuse large B-cell lymphoma complicated by autoimmune hemolytic anemia and pure red cell aplasia.
abstract: A 53-year old man with systemic lymphadenopathy and hepatosplenomegaly was diagnosed with diffuse large B cell-lymphoma after inguinal lymph node biopsy. Anemia was noted, direct and indirect Coombs tests were positive, and the haptoglobin level was low. However, the bone marrow aspirate revealed erythroid aplasia. Co-existing autoimmune haemolytic anemia (AIHA) and pure red cell aplasia (PRCA) were diagnosed. In situ hybridization with Epstein-Barr virus (EBV) encoded small RNA (EBER) showed positive findings in lymphoma cells. Southern blot hybridization revealed immunoglobulin heavy chain gene rearrangement and a clonal EBV terminal repeat, indicating monoclonal proliferation of EBV in infected B cells. The patient was treated with CHOP, resulting in a complete remission (CR). AIHA and PRCA subsided after 3 courses of chemotherapy. In conclusion, this case demonstrates not only the association of B-cell lymphoma with autoimmune disorders but also the involvement of EBV in these conditions.
authors.affiliation: Department of Internal Medicine, National Sanatrium Minami Okayama Hospital, 4066 Hayashima Cho, Tsukubo Gun, Okayama 701-0304, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Katayama
authors.forename: M
authors.initials: M
authors.lastname: Takeuchi
authors.forename: T
authors.initials: T
authors.lastname: Yoshino
authors.forename: M
authors.initials: M
authors.lastname: Munemasa
authors.forename: A
authors.initials: A
authors.lastname: Tada
authors.forename: R
authors.initials: R
authors.lastname: Soda
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000150:complications*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D017403:In Situ Hybridization; D008198:Lymph Nodes / Q000473:pathology* / Q000821:virology; D016393:Lymphoma, B-Cell / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000628:therapy / Q000821:virology; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000150:complications*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone