Detection of human cytomegalovirus in pleural fluid of lymphoblastic lymphoma T-cell type

We report a case of T-lymphoblastic lymphoma in which lymphoma cells infected with cytomegalovirus were found in the pleural fluid. A 16-year-old boy with an anterior mediastinal mass developed pleural fluid accumulation. Immunoperoxidase staining of pathologic cells in the pleural fluid revealed them to be CD4+/-, CD7+, CD8-, CD34+, CD20- and HLA-DR+. The diagnosis of lymphoblastic lymphoma T-cell type was made. Electron microscopic examination revealed virus particles with an electron-dense core and capsid, late structures of virus, in the pleural fluid cells. Polymerase chain reaction (PCR) amplification was used to detect human cytomegalovirus (HCMV) DNA in pleural fluid cells. A pair of synthetic oligonucleotide primers from the CMV phosphoprotein 71, an early structural protein, coding region (HindIII fragments L, c and b of the Ad 169 strain) could amplify DNA from the pleural fluid cells from the patient. Immunoperoxidase staining of the pleural fluid cells with anti-HCMV positive sera also revealed a positive reaction. These findings suggest the entry of HCMV into lymphoma cells with positive PCR amplification of DNA encoding an early structural protein, and replication from the presence of late structures of virus, electron-dense core and capsid. Replication of lymphoid cell lines of B and T origin were reported in the literature but replication of HCMV in lymphoma cells in vivo has not been reported.