Vascular lesion in a patient of chronic active Epstein-Barr virus infection with hypersensitivity to mosquito bites: vasculitis induced by mosquito bite with the infiltration of nonneoplastic Epstein-Barr virus-positive cells and subsequent development of natural killer/T-cell lymphoma with angiodestruction.
This report describes a vasculitis and subsequently developing angiodestructive lymphoma in an 11-year-old Japanese-Filipino girl exhibiting mosquito allergy with the background of chronic active Epstein-Barr virus (EBV) infection. She developed necrotic skin ulcer at the site of mosquito bite, and histopathological examination revealed EBV-positive mononuclear cell infiltration throughout the wall of small-sized muscular artery. These EBV-positive lymphoid cells were oligoclonal in Southern blot analysis for EBV terminal repeats. Effectiveness of steroid therapy also supports the nonneoplastic nature. Approximately 1 year later, she developed progressive large skin ulcer without mosquito bites. Microscopically, the angiocentric or angiodestructive pattern of EBV-positive atypical cells supported the diagnosis of extranodal natural killer/T-cell lymphoma. Southern blot analysis revealed the monoclonal neoplastic nature of EBV-positive cells. In contrast to the primary mosquito bite lesion, natural killer/T-cell lymphoma cells exhibited the higher expression of EBV latent membrane protein 1 mRNA and the apparent protein expression detected by immunohistochemistry.
Kanno
Hiroyuki
H
Department of Pathology, Iwate Medical University School of Medicine, Morioka 020-8505, Japan. hirokan@iwate-med.ac.jp
Onodera
Hanae
H
Endo
Mikiya
M
Maeda
Fumihiko
F
Chida
Shoichi
S
Akasaka
Toshihide
T
Sawai
Takashi
T
D000818:Animals; D002648:Child; D009033:Culicidae; D020031:Epstein-Barr Virus Infections / Q000276:immunology / Q000473:pathology*; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D007299:Insect Bites and Stings / Q000276:immunology / Q000473:pathology* / Q000821:virology; D007694:Killer Cells, Natural / Q000276:immunology; D016410:Lymphoma, T-Cell, Cutaneous / Q000276:immunology / Q000473:pathology*; D009336:Necrosis; D012333:RNA, Messenger / Q000378:metabolism; D012367:RNA, Viral / Q000235:genetics; D012867:Skin / Q000098:blood supply / Q000473:pathology*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000276:immunology / Q000473:pathology*; D014763:Viral Matrix Proteins / Q000235:genetics / Q000378:metabolism
C037662:EBV-associated membrane antigen, Epstein-Barr virus; D012333:RNA, Messenger; D012367:RNA, Viral; D014763:Viral Matrix Proteins