title: Infectious mononucleosis accompanied by clonal proliferation of EBV-infected cells and infection of CD8-positive cells.
abstract: A 22-year-old male was admitted for a sustained fever of 2 months, lymphadenopathy, and liver dysfunction. Anti-VCA-IgM antibody was positive, with elevated Epstein-Barr virus (EBV)-DNA load in the peripheral blood. Liver biopsy revealed infiltration of CD8-positive and EBV-positive cells. Most peripheral blood mononuclear cells (PBMCs) were also positive for CD8, and showed detectable levels of EBV-DNA. Monoclonal proliferation of EBV-infected cells was detected in the PBMCs by Southern blotting for EBV-terminal repeat (EBV-TR). Although EBV-positive T-cell lymphoproliferative disease (EBV-T-LPD) was suspected, the symptoms spontaneously resolved within 12 months. Anti-VCA-IgM antibody and the clonal band of EBV-TR were negative 1 year after the onset, while anti-EBNA antibody was positive. The final diagnosis was thus confirmed as infectious mononucleosis (IM). Our results indicate that EBV-infected CD8-positive cells and clonal proliferation of EBV-infected cells may be temporally detected in IM. EBV-T-LPDs should be carefully excluded in such cases.
authors.affiliation: Department of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 113-8519, Japan, ara.hema@tmd.ac.jp.
authors.forename: Ayako
authors.initials: A
authors.lastname: Arai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Honami
authors.initials: H
authors.lastname: Komatsu
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Imadome
authors.forename: Morito
authors.initials: M
authors.lastname: Kurata
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nagata
authors.forename: Osamu
authors.initials: O
authors.lastname: Miura
mesh_terms: D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology* / Q000378:metabolism / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D016130:Immunophenotyping; D007244:Infectious Mononucleosis / Q000175:diagnosis / Q000276:immunology* / Q000821:virology*; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000378:metabolism / Q000821:virology; D008099:Liver / Q000276:immunology / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology; D008297:Male; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral