Mesh : Adolescent Diagnosis, Differential Epstein-Barr Virus Infections / diagnosis immunology virology Glomerulonephritis / drug therapy immunology Herpesvirus 4, Human / isolation & purification Humans Immunoblastic Lymphadenopathy / diagnosis immunology virology Immunocompromised Host Immunosuppressive Agents / therapeutic use Lymph Nodes / drug effects pathology Lymphadenitis / diagnosis immunology virology Lymphoma, T-Cell / diagnosis immunology virology Male Nephrotic Syndrome / drug therapy immunology Tacrolimus / therapeutic use Treatment Outcome

来  源:   DOI:10.1016/j.humpath.2011.02.024   PDF(Sci-hub)

Abstract:
The development of lymphomas and solid malignancies in association with immunosuppression is a well-documented occurrence in the medical literature. We report the case of a young man who developed progressive diffuse lymphadenopathy with associated extremely high levels of serum Epstein-Barr virus in the setting of chronic immunosuppressive treatment of glomerulonephritis. Excisional biopsy of a right inguinal node revealed a sclerosing process with the morphologic appearance of angioimmunoblastic T-cell lymphoma with a CD3(+), CD4(+) immunophenotype. In situ hybridization of Epstein-Barr virus-encoded RNA was positive. Molecular probe studies demonstrated a clonal T-cell population. Upon reduction of immunosuppression, the patient\'s lymphadenopathy and Epstein-Barr virus titer have resolved without recurrence over 2 years time. This case demonstrates that a benign Epstein-Barr virus-associated process can mimic angioimmunoblastic T-cell lymphoma and should be considered particularly in the setting of immunosuppression, emphasizing the need for close communication with the treating physician in the interpretation of lymph node biopsies.
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