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Updated: Mar 26, 2026

An Efficient and Simple Method to Establish NK and T Cell Lines from Patients with Chronic Active Epstein-Barr Virus Infection
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Acute EBV masquerading as peripheral T-cell lymphoma.

Xiao-Yin Zhang1, Graham P Collins1, Elizabeth Soilleux2

  • 1Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.

BMJ Case Reports
|February 4, 2016
PubMed
Summary

Acute Epstein-Barr virus (EBV) infection can mimic lymphoma, leading to potential misdiagnosis. This case highlights the importance of integrating multiple diagnostic methods to accurately identify EBV and avoid unnecessary lymphoma treatment.

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Area of Science:

  • Hematology
  • Virology
  • Oncology

Background:

  • Peripheral T-cell lymphoma not-otherwise-specified (PTCL-NOS) is a rare and aggressive non-Hodgkin lymphoma.
  • Epstein-Barr virus (EBV) infection can present with diverse clinical and histopathological manifestations.
  • Distinguishing EBV-related lymphoproliferative disorders from true lymphomas is crucial for appropriate patient management.

Observation:

  • A 25-year-old presented with spontaneous splenic rupture and histopathological findings suggestive of PTCL-NOS.
  • T-cell receptor (TCR) PCR studies indicated a monoclonal T-cell population, further supporting a diagnosis of lymphoma.
  • Initial serological tests showed positive EBV IgM and negative IgG, with detectable EBV PCR, indicating acute infection.

Findings:

  • Despite strong histopathological and molecular evidence for PTCL-NOS, the patient was managed conservatively due to suspected acute EBV infection.
  • The patient remained clinically well, with no signs of lymphoma, and subsequently seroconverted to EBV IgG positive.
  • This case underscores that acute EBV can present with features mimicking PTCL-NOS, including lymphocytosis and monoclonal T-cell populations.

Implications:

  • Accurate diagnosis requires a multidisciplinary approach, integrating histopathology, serology, molecular studies, and clinical presentation.
  • Over-reliance on histopathology and clonality studies alone can lead to misdiagnosis of PTCL-NOS in cases of acute EBV infection.
  • Conservative management may be appropriate in select cases where EBV infection is strongly suspected, avoiding potentially toxic chemotherapy for a misdiagnosed lymphoma.