Title: Emperipolesis, Apoptosis and Hemophagocytosis during Acute Epstein-Barr Virus (EBV) infection: A Case Report
Authors: Bandana Mehrotra, Sanjay Mehrotra, Ruchi Shukla, Ashok Kumar Kapoor, Mithlesh Bhargava, Hari Shyam, Supriya Mehrotra, Rajesh Kumar Srivastava, Ambreen Bano
DOI: https://dx.doi.org/10.18535/jmscr/v11i9.03
Abstract
An eight-year-old patient had intermittent high grade fever and pharyngitis since one week. Later, he developed left-sided cervical lymphadenitis. Subsequently, he also developed palatal petechiae. Absolute lymphocyte count (ALC) was raised (ALC 20,262 cells/mm³). Hepatosplenomegaly was also detected. Clinically, the current case was diagnosed as a case of infectious mononucleosis. Possibility of infection by Epstein-Barr virus was considered. FNAC was done. Blood-mixed aspirate showed monocytoid cells with mild pleomorphic nuclei, and clumped chromatin. Inconspicuous nucleoli and abundant eosinophilic cytoplasm were seen. Foci of apoptosis were also seen. Frequent mitoses were seen. Findings were suggestive of acute reactive lymphocytic hyperplasia with hemophagocytosis and apoptosis. EBV DNA was detected by RT PCR with linear reporting range of 3.3×104 IU/ml. Herewith, we describe a case of infectious mononucleosis with emperipolesis and hemophagocytosis.
Keywords: Epstein-Barr virus associated hemophagocytosis syndrome (EBVAHS).
References
- Abdel-Aziz M, El-Hoshy H, Rashed M, Qoth M, Award S, Naguib N. Epstein-Barr virus infection as a cause of cervical lymphadenopathy in children. Int J. Pediat Otorhinolaryngol 2011;75: 564-567.
- Bilal JA. Prevalence and clinical characteristics of primary Epstein-Barr virus infection among children presented with cervical lymphadenopathy. J Clin Diagn Res 2015;9(7): SCO8-SOC10.
- J, Infectious mononucleosis. In Wintrobe's Clinical hematology, Febiger GR, Bithell TC, Foerster JF, Athens JW, Lukens JN (editors). Lee and Febiger, Philadelphia (publishers) 1993,1650-1675.
- Miao Q, Bian Z, Tang R, Zhang H, Wang Q, Huang S, et al. Emperipolesis mediated by T CD8 cells is a characteristic histopathologic feature of autoimmune hepatitis. Clin Res Allerg Immunol Doi 10 1007/s 12016-014-8432-0.
- Henter J, Arico M, Egeler M, Elinder G, Favara BE, Alexandra H, et al. HLH-94: A treatment protocol for hemophagocytic lymphohistiocytosis. Med Pediat Oncol 1997;28:342-7.
- Kawaguchi H, Miyashita T, Herbat H, Niedobitek G, Asada M, Tauchida M, et al. Epstein-Barr-virus-infected T lymphocytes in Epstein-Barr virus-associated hemophagocytic syndrome J Clin Invest 1993; 92: 1444-1450.
- Shimakage MS, Kimura M, Yamona S, Ibe M, Yokota S, Tsujino G, et al. Expression of latent and replicative-infection genes of Epstein-Barr virus in macrophage. Arch virol 1999;144:157-166.
- Okano M, Gross TG. Epstein-Barr virus-associated hemophagocytic syndrome and fatal infectious mononucleosis. Am J Hemat 1996; 53:111-115.
- Humble JG, Jayne WH, Pulvertaft RJ. Biological interaction between lymphocytes and other cells. Brit J Haematol, 1956;2(3): 283-294.
- Schooley RT; Epstein-Barr infection, including infectious mononucleosis In Harrison’s principles of internal medicine 1. 1987; chapter 138:699-703, Mcgraw-Hill book company, New York.
- Lindhout B, Lakeman A, Mevissen MLCM, Groot C de, Functionally active Epstein-Barr virus-transformed follicular dendritic cell-like cell lines. J Exp Med 1994;179:1173-1184.
- Hsieh W-C, Chang Y, Hsu M-C, Lan B-S, Hsiao G-C, Chuang H-C. Emergence of anti-red blood cell antibodies triggers red cell phagocytosis by activated macrophages in a rabbit model of Epstein-Barr virus-associated hemophagocytic syndrome. Am J Pathol 2007; 170 (5): 1629-39.
- Shi M, Chen D. Erythrophagocytosis by neutrophils and megakaryocytic emperipolesis are distinct morphological features in del(20q)-associated myelodysplastic syndrome. Human Pathol: Case reports 2017; 8:69-70.
- Imashuku S, Kuriyama K, Teramura T, Ishii E, Kinugawa N, Kalo M et al. Requirement for Etoposide in the treatment of Ebstein-Barr virus-associated hemophagocytic lymphohistiocytosis. J Cl Oncol 2001;19:2665-73.
- Gerber-Mora R, Lillo VP y, Moreno-Silva R, Gonzalez-Arrinagada W, Fine needle cytology features of an atypical presentation of infectious mononucleosis. J Oral Maxillofacial Pathol 2020;24 (supl 1) S139-S142.