title: Severe chronic active Epstein-Barr virus infection associated with multiple necrotic lesions in the liver.
abstract: We report an atypical presentation of a chronic active Epstein-Barr virus (EBV) infection with multiple nodular coagulation necrosis in the liver, that appeared as hypodense areas on a CT scan. The patient, a 26-year-old man, was hospitalized following over 2 years of intermittent fever, weight loss and liver abnormalities after contracting infectious mononucleosis. We diagnosed his illness as a chronic active EBV infection (CAEBV) because of the high antibody titers against EBV and the histological evidence of organ disease with demonstration of EBV mRNA. A liver biopsy revealed EBV-infected T-cell infiltration with hemophagocytosis and marked hepatocytolytic necrosis. The patient developed multiple coagulation necrosis with well-defined borders surrounding T-cell aggregation in the liver 8 months later. He died of respiratory failure due to interstitial pneumonitis. The analysis of EBV-genome termini demonstrated a clonal proliferation of T-cells harboring EBV, but no T-cell antigen receptor (TCR) gene rearrangement was observed. We speculate that the pathogenesis of this disease was an atypical expression of organ damage as a result of an aberrant T-cell response to EBV infection.
authors.affiliation: Department of Internal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, 228-8555, Kanagawa, Japan
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuchihashi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Atsuko
authors.initials: A
authors.lastname: Takeuchi
authors.forename: Keizou
authors.initials: K
authors.lastname: Sakurai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mitomi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji