1.Persistent Anemia in a Patient with Diffuse Large B Cell Lymphoma: Pure Red Cell Aplasia Associated with Latent Epstein-Barr Virus Infection in Bone Marrow.
Hwa Jung SUNG ; Seok Jin KIM ; Ji Hye LEE ; Goeun LEE ; Kyung A LEE ; Chul Won CHOI ; Byung Soo KIM ; Jun Suk KIM
Journal of Korean Medical Science 2007;22(Suppl):S167-S170
We report a case of pure red cell aplasia (PRCA), which was initially suspected as a result of bone marrow involvement of diffuse large B cell lymphoma. Persistent anemia without an obvious cause was observed in a 47-yr-old man diagnosed with relapsed diffuse large B cell lymphoma. The bone marrow study showed only erythroid hypoplasia without the evidence of bone marrow involvement with lymphoma cells, thus PRCA was suggested. However, parvovirus infection was excluded as a potential cause of PRCA because of negative IgM anti-parvovirus B19 antibody and negative parvovirus PCR in the serum. Latent Epstein-Barr virus (EBV) infection of bone marrow was suggested by in situ hybridization with EBV-encoded small RNA (EBER) that showed a strong positive expression in bone marrow cells. Thus, PRCA was thought to be associated with latent EBV infection in bone marrow cells. Although the finding of unexplained anemia is a possible predictor of bone marrow involvement with lymphoma cells, PRCA as a result of a viral infection including EBV should be considered in lymphoma patients. This is the first report of the occurrence of PRCA associated with latent EBV infection in a patient with non-Hodgkin's lymphoma.
Adult
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Bone Marrow/pathology
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Bone Marrow Diseases/*complications/diagnosis/pathology
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Bone Marrow Neoplasms/pathology
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Diagnosis, Differential
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Epstein-Barr Virus Infections/*complications/diagnosis
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Humans
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Lymphoma, Large B-Cell, Diffuse/*complications/pathology
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Male
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Red-Cell Aplasia, Pure/diagnosis/*etiology
2.Bone Marrow Fibrin-Ring Granuloma: Review of 24 Cases.
Hee Jung CHUNG ; Hyun sook CHI ; Young Uk CHO ; Seongsoo JANG ; Chan Jeoung PARK
The Korean Journal of Laboratory Medicine 2007;27(3):182-187
BACKGROUND: Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma. METHODS: We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group. RESULTS: The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05). CONCLUSIONS: Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.
Adolescent
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Adult
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Aged
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Bone Marrow Diseases/diagnosis/*etiology/pathology
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Child
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Child, Preschool
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Epstein-Barr Virus Infections/*complications/diagnosis
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Female
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Fibrin/analysis
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Granuloma/diagnosis/*etiology/pathology
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Herpesvirus 4, Human/immunology/isolation & purification
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Humans
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In Situ Hybridization
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Male
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Middle Aged
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Polymerase Chain Reaction
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Prognosis
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Q Fever/diagnosis
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Retrospective Studies
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Survival Rate
3.Very Severe Aplastic Anemia appearing after Thymectomy.
Chi Young PARK ; Hee Je KIM ; Yoo Jin KIM ; Yoon Hee PARK ; Jong Wook LEE ; Woo Sung MIN ; Chun Choo KIM
The Korean Journal of Internal Medicine 2003;18(1):61-63
Aplastic anemia is a rare complication of thymoma and is extremely infrequent after thymectomy. We present a case of a 60-year-old woman with very severe aplastic anemia appearing sixteen months after thymectomy for a thymoma. She underwent thymectomy for a thymoma in April 2000. Preoperative examination revealed no hematologic abnormality. About sixteen months after the operation, she was readmitted because of pancytopenia with cough and fever. Bone marrow aspiration revealed a very severe hypoplasia in all the three cell lines with over 80% fatty tissue, and chest CT revealed no recurrence of thymoma. Her aplastic anemia had responded to cyclosporine A and granulocyte-colony stimulating factor (G-CSF).
Anemia, Aplastic/drug therapy/*etiology/*pathology
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Biopsy, Needle
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Bone Marrow/pathology
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Cyclosporine/administration & dosage
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Drug Therapy, Combination
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Female
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Follow-Up Studies
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Granulocyte Colony-Stimulating Factor/administration & dosage
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Humans
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Middle Aged
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Rare Diseases
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Risk Assessment
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Severity of Illness Index
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Thymectomy/*adverse effects/methods
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Thymoma/diagnosis/*surgery
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Treatment Outcome