title: Persistent anemia in a patient with diffuse large B cell lymphoma: pure red cell aplasia associated with latent Epstein-Barr virus infection in bone marrow.
abstract: We report a case of pure red cell aplasia (PRCA), which was initially suspected as a result of bone marrow involvement of diffuse large B cell lymphoma. Persistent anemia without an obvious cause was observed in a 47-yr-old man diagnosed with relapsed diffuse large B cell lymphoma. The bone marrow study showed only erythroid hypoplasia without the evidence of bone marrow involvement with lymphoma cells, thus PRCA was suggested. However, parvovirus infection was excluded as a potential cause of PRCA because of negative IgM anti-parvovirus B19 antibody and negative parvovirus PCR in the serum. Latent Epstein-Barr virus (EBV) infection of bone marrow was suggested by in situ hybridization with EBV-encoded small RNA (EBER) that showed a strong positive expression in bone marrow cells. Thus, PRCA was thought to be associated with latent EBV infection in bone marrow cells. Although the finding of unexplained anemia is a possible predictor of bone marrow involvement with lymphoma cells, PRCA as a result of a viral infection including EBV should be considered in lymphoma patients. This is the first report of the occurrence of PRCA associated with latent EBV infection in a patient with non-Hodgkin's lymphoma.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
authors.forename: Hwa Jung
authors.initials: HJ
authors.lastname: Sung
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Lee
authors.forename: Goeun
authors.initials: G
authors.lastname: Lee
authors.forename: Kyung A
authors.initials: KA
authors.lastname: Lee
authors.forename: Chul Won
authors.initials: CW
authors.lastname: Choi
authors.forename: Byung Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Jun Suk
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D001853:Bone Marrow / Q000473:pathology; D001855:Bone Marrow Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D019046:Bone Marrow Neoplasms / Q000473:pathology; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000473:pathology; D008297:Male; D012010:Red-Cell Aplasia, Pure / Q000175:diagnosis / Q000209:etiology*