1/23. Epstein-Barr virus-associated adult respiratory distress syndrome in a patient with AIDS: a case report and review.BACKGROUND: Epstein-Barr virus (EBV) infection has been associated with fatal pneumonitis in immunocompetent patients. We present a case of fatal adult respiratory distress syndrome caused by EBV infection in a patient with acquired immunodeficiency syndrome (AIDS), to our knowledge the first such reported case, along with a survey of archival autopsy cases to assess baseline expression of EBV in AIDS patients. DESIGN: The case patient's autopsy material was studied exhaustively for infectious agents by culture, histochemistry, and immunohistochemistry, with negative results. Formalin-fixed paraffin-embedded lung, spleen, lymph node, and liver tissue were further studied by in situ hybridization using a probe for EBV early rna (EBER, Kreatech). The same method was applied to lymphoid tissues from eight other archival AIDS autopsy cases. Case patient tissues were also examined by electron microscopy. RESULTS: Strikingly numerous lymphocytes were positive for EBV early rna in the case patient's spleen, lymph nodes, and hepatic portal areas. In addition to positive lymphocytes in the lung, EBV-infected pneumocytes were also present. Electron microscopy also demonstrated viral material in lymphocytes and pneumocytes. Of the archival cases studied, only one spleen was found to have rare positive lymphocytes. CONCLUSION: Primary or reactivation EBV infection may represent a previously underreported cause of morbidity and mortality in AIDS patients. autopsy tissues from AIDS patients do not routinely show overexpression of EBV early rna by in situ hybridization, making this technique ideal for assessing the contribution of EBV to terminal events in these patients.- - - - - - - - - - ranking = 1keywords = hybridization (Clic here for more details about this article) |
2/23. intestinal pseudo-obstruction and acute pandysautonomia associated with Epstein-Barr virus infection.We report the association of neurological and intestinal disorders with the reactivation of Epstein-Barr virus (EBV) in a child. This previously healthy 13-yr-old boy presented with pharyngitis and acute abdominal ileus. laparotomy excluded a mechanical obstruction. Postoperatively, he suffered from prolonged intestinal obstruction, pandysautonomia, and encephalomyelitis. Histological examination of the appendix and a rectal biopsy taken 3 months after the onset showed an absence of ganglion cells (appendix) and hypoganglionosis (rectum), with a mononucleate inflammatory infiltrate in close contact with the myenteric neural plexuses. EBV-PCR was positive in the blood and cerebrospinal fluid, and in situ hybridization with the Epstein-Barr virus encoded rna probe showed positive cells throughout the appendix wall including the myenteric area, in a mesenteric lymph node, and in the gastric biopsies. EBV spontaneous lymphocytic proliferation was noted in the blood. The serology for EBV showed previous infection but anti-early antigen antibodies were present. No immunodeficiency was found. Neurological and GI recovery occurred after 6 months of parenteral nutrition and bethanechol. The omnipresence of EBV associated with the neurointestinal symptoms suggest that the virus was the causal agent. This is the first documented case of acquired hypoganglionnosis due to EBV reactivation.- - - - - - - - - - ranking = 0.5keywords = hybridization (Clic here for more details about this article) |
3/23. Epstein-Barr virus-associated acute interstitial nephritis: infection or immunologic phenomenon?Epstein-Barr virus (EBV) dna in renal tissue in acute interstitial nephritis (IN) has not been previously reported. An 18-year-old male presented with a sore throat, fever, cervical lymphadenopathy, and oliguric renal failure. The rapid slide test for heterophile antibodies associated with infectious mononucleosis was positive, and a renal biopsy showed an acute interstitial nephritis. A polymerase chain reaction (PCR) assay identified EBV dna in the renal biopsy. In situ hybridization (ISH) for EBV rna and immunohistochemistry for latent membrane protein 1 of EBV were negative. Hemodialysis and prednisone 60 mg PO OD were administered and the s-creatinine dropped from 1,224 to 75 micromol/l over 9 days. The identification of EBV dna in the kidney raises the possibility that direct infection plays a role in acute IN associated with EBV.- - - - - - - - - - ranking = 0.5keywords = hybridization (Clic here for more details about this article) |
4/23. Severe gastritis secondary to Epstein-Barr viral infection. Unusual presentation of infectious mononucleosis and associated diffuse lymphoid hyperplasia in gastric mucosa.infectious mononucleosis is usually a self-limited clinical syndrome caused by primary Epstein-Barr virus infection. It is occasionally compounded by severe complications involving many different organ systems. Predominant gastrointestinal involvement is rarely documented. We present an unusual case of acute Epstein-Barr virus infection-associated gastritis with diffuse atypical lymphoid hyperplasia in gastric mucosa. The clinical, radiographic, histopathologic, immunohistochemical, and in situ hybridization features needed for accurate diagnosis and differentiation from gastric malignancies are discussed.- - - - - - - - - - ranking = 0.5keywords = hybridization (Clic here for more details about this article) |
5/23. A pathological and immunohistological case report of fatal infectious mononucleosis, Epstein-Barr virus infection, demonstrated by in situ and Southern blot hybridization.We present an autopsy case of 20-month-old boy who had a fulminant course of infectious mononucleosis, with severe hepatic failure. autopsy revealed marked infiltration of immunoblasts in the lymph nodes, liver, spleen, thymus and kidneys. We identified a large number of Epstein-Barr virus (EBV) genomes in the immunoblasts of the lymph nodes, liver and spleen by in situ hybridization. EBV genomes were also detected in the liver and spleen by Southern blot hybridization. histology of the liver revealed diffuse feathery degeneration of the hepatocytes. However, EBV genomes were not detected in the hepatocytes by in situ hybridization and monoclonal antibody studies. Immunostaining of the autopsy liver specimen revealed a large number of suppressor/cytotoxic T cells (Leu2a positive) in the portal areas and of natural killer (NK) cells (Leu7 positive) in the portal areas and sinusoids of the liver. We therefore suggest that the hepatocellular damage was not caused by the viral replication in the hepatocytes but was mainly caused by the abnormal killer cell activity of the suppressor/cytotoxic T cells and NK cells.- - - - - - - - - - ranking = 3.5keywords = hybridization (Clic here for more details about this article) |
6/23. Epstein-Barr virus infection-associated renal disease: diagnostic use of molecular hybridization technology in patients with negative serology.There are only a few reports of renal disease associated with Epstein-Barr virus (EBV) infection. The diagnosis of EBV infection in these previously reported patients was based primarily on positive serology. Two patients with renal disease who, despite repeatedly negative serologies, were shown by molecular hybridization techniques--in situ hybridization (ISH) and polymerase chain reaction (PCR)--to have EBV infection are reported here. Site-specific molecular probes directed against specific, tandemly repeated EBV genomic regions were used. A synthetic 23-mer terminally biotin-labeled oligonucleotide probe selected from the EBV NotI region was used for ISH. For PCR, oligonucleotide primers were designed from sequences of the highly conserved, long internal direct repeat region of EBV to specifically amplify a 110-base-pair segment. The first patient, a 3-yr-old girl with a 1-yr history of fatigue, fever, splenomegaly, and lymphadenopathy developed hematuria. A renal biopsy revealed widespread glomerular mesangiolysis admixed with segmental mesangial sclerosis; no immune deposits were noted by electron microscopy or immunofluorescence. ISH on paraffin sections of the resected spleen and lymph nodes was positive for EBV. The second patient, a 28-yr-old male renal allograft recipient, received a double dose of OKT3. Seven weeks after transplantation, a renal biopsy revealed a lymphoproliferative disorder. paraffin sections of the nephrectomy specimen were positive for EBV by both ISH and PCR. It was concluded that (1) EBV cannot be excluded on the basis of multiple negative serologies in some patients, and (2) ISH and PCR may lead to the detection of viral genomic information in renal and nonrenal tissues.- - - - - - - - - - ranking = 3keywords = hybridization (Clic here for more details about this article) |
7/23. Primary Epstein-Barr virus infection with clonal T-cell lymphoproliferation.A case of fatal Epstein-Barr virus infection in a previously healthy girl who was first found to have severe infectious mononucleosis with spontaneous recovery is reported. Because an abnormal immune response to the virus persisted, the disease relapsed, manifesting in cutaneous and pulmonary lesions associated with hemophagocytic syndrome responsible for death. Pathologic findings were characterized by polymorphous atypical lymphoid infiltrate, prominent necrosis, and histiocytic hyperplasia. Lymphoid cells displayed CD8 phenotype and clonal T-cell receptor gene rearrangement. Viral genome was detected in lesions by Southern blot and located in nuclei of lymphoid cells by in situ hybridization. Pathologic findings suggested fatal infectious mononucleosis; however, phenotype and genotype favored a malignant diagnosis. Clonality was demonstrated to have arisen during primary infection. Virologic examination indicated that Epstein-Barr virus was a causative agent. Such a process belongs to the recently recognized spectrum of Epstein-Barr virus-related T-cell lymphoproliferative disorders that might overlap fatal infectious mononucleosis in patients who are especially vulnerable to the virus.- - - - - - - - - - ranking = 0.5keywords = hybridization (Clic here for more details about this article) |
8/23. Fatal infectious mononucleosis with evidence suggestive of the development of B cell lymphoma.A 4-year-old girl presented to a local hospital in August 1999 with fever and cervical lymphadenopathy. A diagnosis of Epstein-Barr virus (EBV) infection was made and the patient was treated with corticosteroids. One month later she developed dyspnea secondary to tonsilar swelling, and underwent tonsillectomy and adenoidectomy. Her dyspnea increased, however, and by mid September she required mechanical ventilation. Six weeks later, she was transferred to Chiba Children's Hospital (Chiba, japan). Despite vigorous treatment, she died within four weeks of admission. At autopsy, microscopic examination revealed numerous histiocytes with frequent hemophagocytosis in her lungs, liver, spleen, thymus, and lymph nodes. The tentative diagnosis was EBV-associated hemophagocytic syndrome (EBVAHS). A proliferation of atypical lymphocytes was observed in the lymph nodes, the majority of which stained positive with CD79a antibody. A whitish nodule, 8 mm in diameter, was noted in her right ovary. It consisted of a proliferation of pleomorphic lymphoid cells expressing CD79a antigen. in situ hybridization detected EBV rna within CD79a antigen-positive cells in the lungs, spleen, thymus, bone marrow, lymph nodes, and the right ovary. polymerase chain reaction analysis of dna from the ovarian nodule demonstrated a monoclonal rearrangement of the immunoglobulin heavy chain gene indicating that it consisted of a clone of B lymphocytes. We suggest that EBVAHS develops into polyclonal and monoclonal lymphoproliferative disorder in a short period, and that EBVAHS is a preneoplastic condition that may result in B cell lymphoma.- - - - - - - - - - ranking = 0.5keywords = hybridization (Clic here for more details about this article) |
9/23. Lymph node lesion in infectious mononucleosis showing geographic necrosis containing cytologically atypically B-cells. A case report.Lymph node lesions in infectious mononucleosis (IM) show a marked histological diversity and may occasionally be confused with malignant lymphoma. We report on a rare case of IM showing geographic lymph node necrosis as well as angiocentric lymphoproliferative lesions, and containing numerous centroblasts, immunoblasts and Reed-Sternberg (RS)-like cells. The patient was a 40-year-old Japanese man with signs and symptoms of classical IM. This was later confirmed serologically, but the necrotic area comprised 50% of a cervical lymph node. The large lymphoid cells, including RS-like cells, were CD3-, CD5-, CD15-, CD20 , CD30 , CD45RO-, CD79a , LMPI , and EBNA2 . in situ hybridization study also disclosed that these cells were associated with Epstein-Barr virus (EBV). The patient was disease free during a follow-up of 15 years. Although the classical IM syndrome rarely shows a close resemblance to lymphomatoid granulomatosis of the lymph node or to EBV B- cell lymphoproliferative disorders associated with an immunodeficient state on histology, it is important for pathologists to be aware of this type of lesion in diagnostic practice.- - - - - - - - - - ranking = 0.5keywords = hybridization (Clic here for more details about this article) |
10/23. infectious mononucleosis. diagnosis by in situ hybridization in two cases with atypical features.Two cases of infectious mononucleosis are reported in which in situ hybridization studies were of use to distinguish this disorder from non-Hodgkin's lymphoma. One patient was an 80-year-old man with a tonsillar mass that histologically resembled non-Hodgkin's lymphoma and, on fixed tissue immunohistochemistry, appeared to contain a population of cells anomalously coexpressing the B-cell marker L26 and the T-cell marker Leu-22, suggesting diffuse large-cell non-Hodgkin's lymphoma. The second patient was a 43-year-old woman with inguinal lymphadenopathy that, on histologic examination, also mimicked diffuse large-cell lymphoma. in situ hybridization studies for Epstein-Barr virus revealed both cases to possess EBV dna in a pattern characteristic of infectious mononucleosis. In addition, in situ hybridization studies for immunoglobulin light-chain mRNA demonstrated a polyclonal pattern of kappa and lambda mRNA expression. This report demonstrates the utility of the in situ hybridization technique as an adjunct to routine diagnosis.- - - - - - - - - - ranking = 4keywords = hybridization (Clic here for more details about this article) |
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