11/251. T-gamma gene rearrangement and CMV mononucleosis.A clonal T-gamma rearrangement was found in peripheral blood and bone marrow in a 57-year-old female who presented with 6-week history of fevers, night sweats, and weight loss. splenomegaly, hemolytic anemia, atypical lymphocytosis, a marrow lymphoid aggregate, and elevated LDH had suggested lymphoproliferative disease. However, IgM serology for cytomegalovirus (CMV) was positive. With observation alone, her clinical features improved over 4 weeks with normalization of the blood count and disappearance of CMV viremia and the aberrant T-gamma clone. Acute CMV infection may mimic lymphoproliferative disease. T-gamma gene rearrangement may be part of the immune response to CMV infection and is not specific to lymphoid neoplasia.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/251. Alterations of the X-linked lymphoproliferative disease gene SH2D1A in common variable immunodeficiency syndrome.X-linked lymphoproliferative (XLP) disease is a primary immunodeficiency caused by a defect in the SH2D1A gene. At least 3 major manifestations characterize its clinical presentation: fatal infectious mononucleosis (FIM), lymphomas, and immunoglobulin deficiencies. common variable immunodeficiency (CVID) is a syndrome characterized by immunoglobulin deficiency leading to susceptibility to infection. In some patients with CVID, a defective btk or CD40-L gene has been found, but most often there is no clearly identified etiology. Here, 2 unrelated families in whom male members were affected by CVID were examined for a defect in the XLP gene. In one family previously reported in the literature as having progressive immunoglobulin deficiencies, 3 brothers were examined for recurrent respiratory infections, whereas female family members showed only elevated serum immunoglobulin a levels. A grandson of one of the brothers died of a severe aspergillus infection secondary to progressive immunoglobulin deficiency, FIM, aplastic anemia, and B-cell lymphoma. In the second family, 2 brothers had B lymphocytopenia and immunoglobulin deficiencies. X-linked agammaglobulinemia syndrome was excluded genetically, and they were classified as having CVID. The occurrence of FIM in a male cousin of the brothers led to the XLP diagnosis. Because the SH2D1A gene was found altered in both families, these findings indicate that XLP must be considered when more than one male patient with CVID is encountered in the same family, and SH2D1A must be analyzed in all male patients with CVID. Moreover, these data link defects in the SH2D1A gene to abnormal B-lymphocyte development and to dysgammaglobulinemia in female members of families with XLP disease.- - - - - - - - - - ranking = 1.5keywords = infection (Clic here for more details about this article) |
13/251. Positive Epstein-Barr virus heterophile antibody tests in patients with primary human immunodeficiency virus infection.PURPOSE: To describe three cases of primary human immunodeficiency virus (hiv) infection in patients who had laboratory studies consistent with infectious mononucleosis. SUBJECTS: We describe 3 patients who presented with a viral syndrome, had a positive heterophile antibody test, and were diagnosed with primary hiv infection. RESULTS: The results of Epstein-Barr virus serology studies in each of these patients were consistent with chronic, but not acute, Epstein-Barr virus infection. hiv antibody tests were negative, and hiv rna was >500,000 copies/mL in each patient. CONCLUSIONS: Clinicians should recognize that a positive heterophile antibody test in the setting of an acute viral illness does not exclude the diagnosis of primary hiv infection, although reactivation of latent Epstein-Barr virus infection cannot be ruled out. patients presenting with nonspecific viral syndromes should be assessed for hiv risk behaviors and tested for primary hiv infection when appropriate.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
14/251. Transient lupus anticoagulant and prolonged activated partial thromboplastin time secondary to Epstein-Barr virus infection.We describe the case of a previously well 19-month-old boy who presented with an acute Epstein-Barr virus infection and a prolonged activated partial thromboplastin time (APTT) associated with the presence of a transient lupus anticoagulant (LA). The boy had an excellent outcome, with gradual normalization of the APTT and disappearance of the LA.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
15/251. Severe hypoglycaemia in a patient with glycogen storage disease type iii induced by infectious mononucleosis.A 10-month-old girl with glycogen storage disease type iii developed recurrent severe hypoglycaemia induced by infectious mononucleosis. Severe metabolic damage probably reflected a rapid breakdown of liver cells induced by the viral infection.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
16/251. Systemic lupus erythematosus induced by Epstein-Barr virus infection.We report a 22-year-old woman who developed systemic lupus erythematosus (SLE) immediately after an Epstein-Barr virus (EBV)-induced mononucleosis infection. The link between these two conditions has long been suspected. The close temporal relationship, the course of the pathological events and the development of immunological changes in this case provide further evidence supporting the hypothesis that EBV infection could work as a trigger in some cases of SLE, particularly if the patient is genetically susceptible.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
17/251. Peripheral blood lymphocyte apoptosis: a clue to the diagnosis of acute infectious mononucleosis.OBJECTIVE: To describe the morphology and significance of apoptotic lymphocytes in peripheral blood smears of patients with acute infectious mononucleosis. To our knowledge this has not been previously reported. DESIGN: Peripheral blood smears from 27 patients with a positive heterophile antibody test were collected and reviewed for the presence of apoptotic lymphocytes. flow cytometry was performed on three cases to document the previously described low expression of bcl-2 in lymphocytes in infectious mononucleosis. Four control patient populations comprising 80 cases were similarly screened for the presence of apoptotic lymphocytes. SETTING: The specimens were collected over a 3-month period in two laboratories at our tertiary care hospital; all specimens were processed according to a standard protocol. patients: young adult military recruits and their spouses, military dependent adolescents, and retired military personnel. RESULTS: Twenty-four (88.9%) of 27 peripheral blood smears of patients with acute infectious mononucleosis contained readily identifiable apoptotic lymphocytes. Three (3.75%) of 80 control peripheral blood smears were identified with rare apoptotic lymphocytes, all occurring in patients with viral upper respiratory infections. CONCLUSIONS: The finding of apoptotic lymphocytes in a peripheral blood smear is useful in the differential diagnosis of infectious mononucleosis and neoplastic hematolymphoid processes.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
18/251. Active infective endocarditis due to methicillin-resistant staphylococcus aureus in the acute phase of infectious mononucleosis.A 26-year-old male was treated for acute hepatitis due to Epstein-Barr virus and infectious mononucleosis in our hospital. At 2 weeks after admission, there was relapse with high fever. A blood culture detected methicillin-resistant staphylococcus aureus. A two-dimensional echocardiogram revealed severe aortic regurgitation and vegetation on the left coronary cusp of the aortic valve. The diagnosis was active infective endocarditis due to methicillin-resistant staphylococcus aureus in the acute phase of infectious mononucleosis. Following preoperative administration of vancomycin, the aortic valve was replaced with a Carbomedics prosthetic valve. The aortic valve was bicuspid, and the right cusp and non-coronary cusp were conjoined. As the focus of infection was localized to the left coronary cusp, the infected tissue was fully removed with resection of all the cusps. Although fever persisted long after the operation, the blood culture became negative for methicillin-resistant staphylococcus aureus, and repeated echocardiograms including transesophageal echocardiogram showed no prosthetic valve infection. vancomycin was administered until the c-reactive protein became negative at 45 days after the operation.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
19/251. Transverse myelitis associated with mycoplasma pneumoniae pneumonitis: a report of two cases.The authors report two cases of transverse myelitis due to mycoplasma pneumoniae occurring during a recent acute infection due to Epstein-Barr virus (EBV). The clinical picture included weakness of the legs, bladder dysfunction, fever, headache and in one case, a mild confusional state. magnetic resonance imaging (MRI) revealed a segmental edema of the lumbar tract and cerebro-spinal fluid analysis showed a mild pleocytosis and an increased level of proteins with a blood-brain barrier damage. The diagnosis of acute infection due to mycoplasma pneumoniae was made on serological criteria. The patients recovered completely after a 14-day course of an associated regimen with ciprofloxacin (400 mg/day i.v.) plus prednisone (60 mg/day i.v.). The authors emphasise the immunological disorders in the combined infection with mycoplasma pneumoniae and EBV, supposing that an infective mononucleosis may predispose to mycoplasmic transverse myelitis.- - - - - - - - - - ranking = 1.5keywords = infection (Clic here for more details about this article) |
20/251. 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 = 2.5keywords = infection (Clic here for more details about this article) |
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