Epstein barr virus hemophagocytic lymphohistiocytosis related to rituximab use and immunopathogenetic insights.
Anti-CD20-based chemo-immunotherapeutic regimens have been suggested to assist in the management of Epstein-Barr virus (EBV)-induced hemophagocytic lymphohistiocytosis (HLH) and EBV-associated post-transplant lymphoproliferative disorders (EBV-PTLD), by reducing EBV viral load and EBV-induced inflammation. Herein we report a fatal EBV-related HLH in the context of Hodgkin lymphoma (HL)-like Richter's transformation of B chronic lymphocytic leukemia (B-CLL), two months after rituximab treatment. The complex balance between EBV driven T-cell stimulation and immunosuppressive therapy in the context of multiple immune deficits is discussed.
2nd Department of Internal Medicine, Propaedeutic, Hematology Unit, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Haidari, Greece. Electronic address: sotirispapageorgiou@hotmail.com.
Sotirios G
SG
Papageorgiou
4th Department of Internal Medicine, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Sotirios
S
Tsiodras
4th Department of Internal Medicine, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Georgios
G
Siakallis
2nd Department of Internal Medicine, Propaedeutic, Hematology Unit, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Haidari, Greece.
Efthimia
E
Bazani
Department of Pathology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Aris
A
Spathis
4th Department of Internal Medicine, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Garyfalia
G
Poulakou
1st Department of Pathology, "Laikon" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Penelope
P
Korkolopoulou
Department of Pathology, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Ioannis
I
Panayiotides
2nd Department of Internal Medicine, Propaedeutic, Hematology Unit, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Haidari, Greece.
Vasiliki
V
Pappa
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000473:pathology*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000473:pathology*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000473:pathology* / Q000821:virology; D008297:Male; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000473:pathology; D000069283:Rituximab / Q000009:adverse effects*; D014775:Virus Activation
D000970:Antineoplastic Agents; D000069283:Rituximab
Anti-CD 20; EBV; Epstein barr virus; Hemophagocytic lymphohistiocytosis; Hodgkin lymphoma; Richter’s; Rituximab