title: Epstein-Barr virus (EBV) serology for predicting distant metastases in a white juvenile patient with nasopharyngeal carcinoma and no clinical response to EBV lytic induction therapy.
abstract: BACKGROUND
  We describe a case of a 16-year-old white girl with Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC). METHODS.: At diagnosis, the patient had characteristic immunoglobulin (Ig)A and IgG responses to EBNA1, viral capsid antigen (VCA)-p18, and early antigens (EAs), with no detectable EBV DNA in her blood. Combined chemotherapy and radiotherapy resulted in complete remission. Eighteen months later, the patient's IgA responses to EBNA1 and p18 and both IgA and IgG anti-EA increased, without apparent recurrence. Five months later, lung metastases were found. She underwent surgical removal of the lung metastases and conventional chemotherapy, but had intraabdominal lymph node metastasis and mediastinal lesions develop. The patient was then treated with a novel treatment consisting of 5-fluorouracil plus valproic acid and subsequent valganciclovir to induce lytic EBV replication. This resulted in the first detectable EBV DNA levels in the blood but did not result in clinical response.
  
  
  RESULTS
  The patient's disease progressed, and the patient declined further cancer treatment and died.
  
  
  CONCLUSIONS
  In contrast to EBV DNA load, EBV serology was useful in predicting distant NPC metastasis after initial complete remission in this patient.
authors.affiliation: Department of Pathology, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. s.stevens@vumc.nl
authors.forename: Servi J C
authors.initials: SJ
authors.lastname: Stevens
authors.forename: Christian M
authors.initials: CM
authors.lastname: Zwaan
authors.forename: Sandra A W M
authors.initials: SA
authors.lastname: Verkuijlen
authors.forename: Jaap M
authors.initials: JM
authors.lastname: Middeldorp
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood*; D017809:Fatal Outcome; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D008175:Lung Neoplasms / Q000097:blood / Q000556:secondary / Q000821:virology; D008207:Lymphatic Metastasis; D009303:Nasopharyngeal Neoplasms / Q000097:blood / Q000473:pathology* / Q000628:therapy / Q000821:virology*; D009362:Neoplasm Metastasis; D012698:Serologic Tests
chemical_list: D000914:Antibodies, Viral; D007070:Immunoglobulin A; D007074:Immunoglobulin G