title: Epstein-Barr virus infection associated with bone marrow fibrin-ring granuloma.
abstract: We previously reported 24 cases of marrow fibrin-ring granuloma (FRG) encountered in 1 institution and concluded that, contrary to previous studies showing marrow FRG as a diagnostic marker for Q fever, Epstein-Barr virus (EBV) was the most common proven cause of such FRG. The present study characterized patients with EBV-associated marrow FRG. We retrospectively reviewed 17 cases of EBV-associated FRG (43% of 40 cases with marrow FRG) diagnosed by bone marrow biopsy. Patients with EBV-associated hemophagocytic lymphohistiocytosis (5/17 patients) and chronic active EBV infection (4/17) constituted 53% of patients with EBV-associated FRG. Three patients had lymphoma without marrow involvement. All patients except 1 presented first with fever; splenomegaly was the next most common clinical finding (12/17). Cytopenia was observed in the 17 cases: anemia in 16, thrombocytopenia in 9, and leukopenia in 8. Patients with EBV-associated FRG showed lower survival outcomes than did patients without EBV (median, 3.0 vs 11.8 months; P = .009). Patients with bone marrow FRG accompanied by fever require careful evaluation to discern whether active EBV infection is involved because the prognosis is poor.
authors.affiliation: Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Songpa-gu, Seoul, Republic of Korea (South Korea) 138-736.
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Chung
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Chi
authors.forename: Seongsoo
authors.initials: S
authors.lastname: Jang
authors.forename: Chan-Jeoung
authors.initials: CJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001855:Bone Marrow Diseases / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D005337:Fibrin; D006099:Granuloma / Q000821:virology*; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D005337:Fibrin