title: Morphological and molecular diagnosis of a fatal form of EBV infectious mononucleosis in a child.
abstract: Mortal cases of acute Epstein-Barr virus (EBV) infection in the form of mononucleosis have been seldom described and used to be related to complications of the disease. In this report, the case of a 3-year-old girl is described, with severe form of infectious mononucleosis, deceased in the course of respiratory-circulatory insufficiency with a sudden cessation of heart action. Particular attention was given to histological lesions, phenotype of inflammatory cells and to expression of proteins and EBV RNAs (EBERs) in tissues, examined using immunocytochemical techniques and in situ hybridization. Histological patterns were dominated by massive lymphocyte infiltrates (mostly CD45RO+ and CD3+ cells), mainly in lungs and in liver and, less pronounced, in kidneys and in leptomeninx. Lymphocyte proliferation exhibited polyclonal character: both lambda and kappa chains were present. No myeloblastic differentiation could be demonstrated. The EBV proteins, as well as EBV RNAs (EBERs) were detected both in small lymphocytes B and in enlarged (blast) cells, frequently resembling Reed-Sternberg cells. In our tissue material co-expression of the two proteins (EBNA2+, LMP1+) and EBER has been demonstrated in every organ, in accordance to the latency III pattern described by other authors.
authors.affiliation: Department of Histology and Embryology, Karol Marcinkowski University of Medical Sciences, Poznań. akasprza@amp.edu.pl
authors.forename: Aldona
authors.initials: A
authors.lastname: Kasprzak
authors.forename: Magdalena
authors.initials: M
authors.lastname: Mrówczyńska
authors.forename: Jacek
authors.initials: J
authors.lastname: Wysocki
authors.forename: Donata
authors.initials: D
authors.lastname: Jurczyszyn
authors.forename: Aldona
authors.initials: A
authors.lastname: Woźniak
authors.forename: Rafał
authors.initials: R
authors.lastname: Spachacz
authors.forename: Wiesława
authors.initials: W
authors.lastname: Biczysko
mesh_terms: D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D017403:In Situ Hybridization; D007244:Infectious Mononucleosis / Q000473:pathology* / Q000821:virology*; D008198:Lymph Nodes / Q000473:pathology / Q000821:virology; D008214:Lymphocytes / Q000473:pathology; D025202:Molecular Diagnostic Techniques; D012367:RNA, Viral / Q000032:analysis; D016601:RNA-Binding Proteins / Q000032:analysis; D012269:Ribosomal Proteins / Q000032:analysis
chemical_list: D012367:RNA, Viral; D016601:RNA-Binding Proteins; D012269:Ribosomal Proteins; C067169:RPL22 protein, human