Epstein-Barr virus load correlating with clinical manifestation and treatment response in a patient with angioimmunoblastic T-cell lymphoma.
Epstein-Barr virus (EBV)-associated lymphoma may arise secondary to angioimmunoblastic T-cell lymphoma (AITL). The prognosis is poor despite chemotherapy and experimental therapies. We report on a 40-year-old woman with AITL without obvious immunodeficiency in which EBV-associated lymphoma developed. The occurrence and size of enlarged lymph nodes correlated strongly with the EBV load in serum (EBVL). Treatment with valacyclovir at the early stage resulted in a drastic more than 3 log10 decrease of EBVL and complete remission. However, valacyclovir had to be stopped after 6 months due to side effects, and the lymphoma reoccurred 3 months later associated with increasing EBVL. Eventually started cytotoxic chemo- and anti-CD20 therapy resulted only in partial remission. The lymphoma progressed and 33 months after it was diagnosed the patient died. This case report demonstrates the close association of EBVL and AITL and a beneficial effect of antiviral therapy at an initial stage of disease manifestation.
Battegay
Manuel
M
Division of Infectious Diseases, Department of Internal Medicine & Research, University Hospital of Basel, Basel, Switzerland. mbattegay@uhbs.ch
Berger
Christoph
C
Rochlitz
Christoph
C
Hurwitz
Nina
N
Hirsch
Hans H
HH
De Geyter
Christian
C
Haque
Tanzina
T
Nadal
David
D
D000212:Acyclovir / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D004854:Herpesvirus 4, Human / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007119:Immunoblastic Lymphadenopathy / Q000188:drug therapy* / Q000473:pathology / Q000821:virology*; D007121:Immunocompetence; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D016399:Lymphoma, T-Cell / Q000188:drug therapy* / Q000473:pathology / Q000821:virology*; D012367:RNA, Viral / Q000302:isolation & purification; D011859:Radiography; D013194:Staining and Labeling; D000077483:Valacyclovir; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000302:isolation & purification
D000998:Antiviral Agents; C037662:EBV-associated membrane antigen, Epstein-Barr virus; C099537:Epstein-Barr virus encoded RNA 1; D012367:RNA, Viral; D014763:Viral Matrix Proteins; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir