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Published on: March 30, 2018
Central nervous system involvement of Epstein-Barr virus lymphoproliferative disease in a patient with acute
S S Drury1, R K Sathiapalan, R P Warrier
1Department of Biometry and Genetics, Louisiana State University Medical Center, Children's Hospital of New Orleans, USA.
Insights
Epstein-Barr virus-related lymphoproliferative disease (EBV-LPD) can occur in immunocompromised patients. This case study shows a child with acute lymphocytic leukemia who recovered from multiple EBV-LPD episodes with careful monitoring and treatment.
Area of Science:
- Oncology
- Virology
- Immunology
Background:
- Epstein-Barr virus-related lymphoproliferative disease (EBV-LPD) is a severe complication in immunocompromised individuals.
- Acute lymphocytic leukemia (ALL) treatment often involves immunosuppression, increasing EBV-LPD risk.
Observation:
- A 6-year-old boy with ALL developed three distinct EBV-LPD episodes in the lymph node, CNS, and liver.
- These episodes occurred during and after chemotherapy, confirmed by in situ hybridization for EBV.
Findings:
- The patient received various treatments including acyclovir, intravenous gamma globulin, and surgery.
- Complete recovery was achieved with normal organ function and sustained leukemia remission for 6 years post-chemotherapy.
Implications:
- This case highlights the importance of vigilant monitoring for EBV-LPD in immunocompromised patients.
- Successful outcomes can be achieved through prompt diagnosis, multimodal treatment, and potentially novel immune therapies.
Abstract:
Epstein-Barr virus-related lymphoproliferative disease (EBV-LPD) is a serious and often fatal complication of a variety of immune-suppressed conditions. A 6-year-old boy undergoing chemotherapy for standard-risk acute lymphocytic leukemia experienced separate episodes of EBV-LPD in different organ systems. The patient experienced three separate episodes of EBV-LPD in the cervical lymph node, the central nervous system (CNS), and the liver occurring, respectively, in January 1992, February 1992, and November 1993 after the completion of chemotherapy in May 1993. The EBV presence was confirmed by in situ hybridization in the biopsy samples from each lesion. Several different treatment modalities, including acyclovir, intravenous gamma globulin, and surgery were used to combat the EBV-LPD. The patient has recovered completely, with normal CNS and liver function, and for the past 6 years has experienced leukemia remission while not receiving chemotherapy. Careful monitoring of patients and the use of new immune therapies offer the highest chance for successful outcomes in such patients.
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