title: Long-term follow-up of EBV-positive lymphoproliferative disorders in a patient with systemic lupus erythematosus.
abstract: We report a woman in her early thirties with a long-term history of systemic lupus erythematosus (SLE) and prednisolone administration, who progressed to Epstein-Barr virus (EBV)-positive lymphoproliferative disorder (LPD). Treatment for SLE consisted of 1 mg/kg/ day prednisolone followed by 5 mg/day of maintenance therapy. Lymph node biopsies were performed when the patient was in her early thirties, mid-forties, and late fifties. Histologically, the initial lymph node lesion was characterized by numerous enlarged, coalescing lymphoid follicles. The second biopsy showed effacement of the follicles and expansion of the paracortical area. A polymorphous population of small- to medium-sized lymphocytes, plasma cells, and immunoblasts had diffusely infiltrated the paracortical area. In the third lymph node biopsy, fibrous collagen bands divided the epithelioid cell granulomas into nodules. There were numerous Hodgkin and Reed-Sternberg cells in the epithelioid cell granuloma. In situ hybridization demonstrated there were no EBV-infected lymphocytes in the first biopsy; however, EBER(+) cells were detected in the second and third biopsy specimens. The current findings illustrate the natural progression in a patient with a long-term history of EBV(+) B-cell LPD in which the immunodeficiency was caused by SLE and probably her aging, which together resulted in histological change.
authors.affiliation: Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan. ntukamot@med.gunma-u.ac.jp
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Handa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yokohama
authors.forename: Takeki
authors.initials: T
authors.lastname: Mitsui
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saitoh
authors.forename: Hiromi
authors.initials: H
authors.lastname: Koiso
authors.forename: Hideki
authors.initials: H
authors.lastname: Uchiumi
authors.forename: Takumi
authors.initials: T
authors.lastname: Hoshino
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Karasawa
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Murakami
authors.forename: Masaru
authors.initials: M
authors.lastname: Kojima
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
mesh_terms: D000328:Adult; D000375:Aging; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D004854:Herpesvirus 4, Human; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D008198:Lymph Nodes / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D011239:Prednisolone / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone