title: Flow cytometric analysis of skin blister fluid induced by mosquito bites in a patient with chronic active Epstein-Barr virus infection.
abstract: In chronic active Epstein-Barr virus (EBV) infection (CAEBV), ectopic EBV infection has been described in T or natural killer (NK) cells. NK cell-type infection (NK-CAEBV) is characterized by large granular lymphocytosis, high IgE levels and unusual reactions to mosquito bites, including severe local skin reactions, fever and liver dysfunction. However, the mechanisms underlying these reactions remain undetermined. Herein, we describe a patient with NK-CAEBV whose blister fluid after mosquito bites was analyzed. The patient exhibited significant increases in the percentage of CD56(+) NK cells in the fluid compared with a simple mosquito allergy, in which the majority of infiltrated cells were CD203c(+) cells, indicating basophils and/or mast cells. His fluid also contained CD203c(+) cells, and his circulating basophils were activated by mosquito extracts in vitro. These results suggest that CD203c(+) cells as well as NK cells may play pathogenic roles in the severe skin reactions to mosquito bites in NK-CAEBV.
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan. taizo@ped.m.kanazawa-u.ac.jp.
authors.forename: Taizo
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Tadafumi
authors.initials: T
authors.lastname: Yokoyama
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Erika
authors.initials: E
authors.lastname: Asai
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Toga
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Sakakibara
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Fumie
authors.initials: F
authors.lastname: Shibata
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Tone
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Toma
authors.affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yachie
mesh_terms: D000818:Animals; D001768:Blister / Q000209:etiology*; D001826:Body Fluids; D002648:Child; D002908:Chronic Disease; D009033:Culicidae; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D007299:Insect Bites and Stings / Q000473:pathology / Q000821:virology*; D007694:Killer Cells, Natural / Q000473:pathology; D008297:Male; D010727:Phosphoric Diester Hydrolases / Q000032:analysis; D011755:Pyrophosphatases / Q000032:analysis
chemical_list: C427944:ENPP3 protein, human; D010727:Phosphoric Diester Hydrolases; D011755:Pyrophosphatases