Evolution of infectious mononucleosis into Epstein-Barr virus carrying monoclonal malignant lymphoma

A monoclonal malignant lymphoma was diagnosed in a 30-month-old Japanese boy, who, since the age of 12 months, had had chronic, recurrent infectious mononucleosis manifested by repeated episodes of severe cough and high fever accompanied by marked lymphadenopathy and hepatosplenomegaly and high serum Epstein-Barr virus (EBV) antibody titres. The diagnosis of Burkitt's lymphoma was made when a cervical lymph-node biopsy specimen revealed massive proliferation of immature B-cells with starry-sky histiocytes. These lymph-node cells were characterised by a translocation between chromosomes 10 and 17. There were approximately 9 EBV genome-equivalents per cell. Most cells were positive for nuclear antigen (EBNA); early antigen (EA) and viral capsid antigen (VCA) were also detected. The presence of EBV was supported by finding that the cell-free lymph-node extract transformed cord-blood lymphocytes into EBNA-positive blast cells. The proportion of EA-positive and VCA-positive cells increased rapidly in culture for 24 h, then the positive cells degenerated rapidly and completely. The cells also contained numerous herpes-type virus particles. The child improved considerably with cytostatic treatment and has been in remission for 2 years.