Chronic Epstein Barr virus infection leading to classical Hodgkin lymphoma

Abstract

BackgroundChronic Epstein Barr virus (EBV) infection in an immunocompetent host has been described however it is not a common entity. It has been linked to many lymphoproliferative disorders and achieves such via many molecular mechanisms, some of which are poorly understood. In addition to infectious mononucleosis, the EBV is linked to various other hematological pathologies and autoimmune disorders.Case presentationWe describe the case of an elderly immunocompetent female who presented with non-specific symptomatology, lymphadenopathy, cytopenias, elevated autoantibody titers and a crescent EBV viral load that were suggestive of a multisystemic inflammatory disease related to EBV. Extensive work up including multiple bone marrow biopsy and lymphoid tissue procedures ultimately led to the diagnosis of Hodgkin lymphoma.ConclusionEBV-related lymphomagenesis is complex and through the utilization of its nuclear antigens and latent membrane proteins the virus is able to shape the microenvironment to promote the various pathologies seen. Moreover, the diagnosis of EBV-associated lymphoproliferative disorders might be challenging when they present in immunocompetent individuals. Our case also represents an emphatic reminder for clinicians that spontaneous regression of lymphadenopathy is not exclusive of low-grade lymphoid malignancies.

Herpesvirus Infections and Alzheimer’s Disease: A Mendelian Randomization Study 

“…Our MR nding was from the aspect of mononucleosis other than the latent infection. In light of the fact that over 90% of the world's adult population is chronically infected with EBV [34], our results from mononucleosis seem to be more practical, which might imply the underlying effects of immune mechanisms and provide contributions to the current literature [6].…”

Interferon-alpha-2a as a salvage treatment for hemorrhagic enteritis associated with Epstein-Barr Virus reactivation : a case report

“…EBV infects ≈90% of humans and -following the acute phase of infection-persists lifelong in a latent phase in B cells (5). EBV viral replication is promoted by immunodeficiency states (i.e.…”

Epstein-Barr virus and its association with disease - a review of relevance to general practice

“…Whether an individual develops IM primarily depends on the timing of exposure to the virus. Young children rarely develop clinical signs of IM, whereas up to 70% [10] of adolescents and adults will present with the classical symptomatic triad of about two to four weeks of fever, pharyngitis and cervical lymphadenopathy with lymphocytosis [1]. The risk of severe symptoms is positively correlated to the age of the patient at time of primary infection [11].…”

“…Epstein-Barr virus (EBV) is a double-stranded DNA virus belonging to the Herpes family and the primary cause of infectious mononucleosis (IM), a common infection worldwide with a lifetime prevalence of 90% [1]. Symptoms of IM, so-called glandular fever usually manifest after an incubation period of four to seven weeks, and include fever, lymphadenopathy and pharyngitis.…”