Infectious Mononucleosis in an Adult Progressing to Fatal lmmunoblastic Lymphoma

doi:10.1059/0003-4819-96-6-737

Infectious Mononucleosis in an Adult Progressing to Fatal lmmunoblastic Lymphoma

Boston and Worcester, Massachusetts; and New Haven, Connecticut

Abstract

We report a case of infectious mononucleosis progressing to fatal immunoblastic lymphoma. The patient, a 44-year-old man who may have had an immunoregulatory defect, failed to have an appropriate T-cell response to his Epstein-Barr (EB) viral infection. His active EB viral infection was manifest by seroconversion of IgM-viral capsid antibody and a greater than four fold rise in IgG-viral capsid antibody. Also, he transmitted his EB viral infection to his wife who became ill 1 month after his death. Clinically the patient's illness was characterized by waxing and waning lymphadenopathy, persistent fever, diarrhea (similar to that associated with cholera), a coagulopathy, and gastrointestinal bleeding. The patient had pathologic findings of a diffuse immunoblastic lymphoma involving lymph nodes, small bowel, liver, pancreas, kidneys, lungs, and bone marrow. Immunologic cell markers showed the tumor to be polyclonal.

Article and Author Information

▸From the Departments of Medicine and Pathology, New England Medical Center Hospital, Tufts University School of Medicine, Boston, Massachusetts; the Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, Massachusetts; and the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.
Grant support: in part by grants 5S02RR05598-09 and CA 12952, National Cancer Institute. David R. Snydman, M.D. is a Teaching and Research Scholar of the American College of Physicians.
▸Requests for reprints should be addressed to David R. Snydman, M.D.; Box 238, New England Medical Center, 171 Harrison Avenue; Boston, MA 02111.