To improve the diagnosis of atypical lymphocytes and reduce the misdiagnosis rate,we analyzed the medical records of 2 cases with cell morphology suggestive of atypical lymphocytes.One case was diagnosed with infectious mononucleosis and the other with aggressive NK cell leukemia.The purpose of this paper is to emphasize that the diagnosis of atypical lymphocytes based only on morphological interpretation of cells may be incorrect,which should be combined with clinical symptoms,signs,imaging examination,cell immunophenotype,and disease outcome.
Humans ; Lymphocytosis/diagnosis* ; Infectious Mononucleosis/diagnosis* ; Immunophenotyping ; Diagnosis, Differential ; Diagnostic Errors

OBJECTIVE: To investigative the detection value of EB virus DNA (EBV-DNA), interleukin-2 (IL-2), and interleukin-6 (IL-6) level in peripheral blood of children with infectious mononucleosis (IM). METHODS: A total of 59 children clinically confirmed with IM in Anhui Provincial Children's Hospital from January 2018 to September 2020 were enrolled as IM group, while other 30 healthy children undergoing physical examination during the same period were enrolled as healthy group. The level of EBV-DNA load, IL-2, and IL-6 were compared between the two groups, and their diagnostic values for IM children were explored. According to the median level of EBV-DNA load, positive children were divided into high viral load group and low viral load group. The hepatomegaly and splenomegaly, and levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), IL-2, and IL-6 were compared between the two groups. The relationship between EBV-DNA load and IL-2, IL-6 levels were explored. RESULTS: The positive rate of EBV-DNA was 67.80% in IM group, which was significantly higher than 10.00% in healthy group (P<0.001), and the levels of serum IL-2 and IL-6 were also significantly higher than healthy group (P<0.001). The results of ROC curve analysis showed that AUC of IL-2 combined with IL-6 and EBV-DNA load was 0.948, which was significantly greater than that of IL-2, IL-6, and EBV-DNA load alone (0.847, 0.728, 0.789) (P<0.001). The cut-off value of IL-2 and IL-6 was 15.545 pg/ml and 56.560 pg/ml, respectively. Both the proportions of cases with moderate to severe hepatomegaly and splenomegaly in high viral load group were significantly higher than those in low viral load group (P<0.01, P<0.05). The levels of ALT, AST, and IL-2 in high viral load group were significantly higher than those in low viral load group (P<0.001), as well as IL-6 (P<0.01). In high and low viral load groups, EBV-DNA load was positively correlated with IL-2 and IL-6 (in high viral load group, r_IL-2=0.598, r_IL-6=0.416; in low viral load group, r_IL-2=0.621, r_IL-6=0.527, P<0.001). CONCLUSION The detection of EBV-DNA load combined with IL-2 and IL-6 can improve the diagnostic accuracy of IM, and EBV-DNA load, IL-2 and IL-6 levels are related to the disease progression.
Child ; DNA, Viral ; Epstein-Barr Virus Infections ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Infectious Mononucleosis/diagnosis* ; Interleukin-2/blood* ; Interleukin-6/blood* ; Splenomegaly

Humans ; Infectious Mononucleosis/complications* ; Lymphocytosis ; Lymphohistiocytosis, Hemophagocytic/etiology*

OBJECTIVE: To study the clinical effect of recombinant human interferon α1b assisting acyclovir on immune function, inflammatory factors, and myocardial zymogram in children with infectious mononucleosis (IM). METHODS: A total of 182 children with IM who were admitted to the hospital from January to December, 2018, were divided into an observation group with 91 children and a control group with 91 children using a random number table. The children in the control group were treated with intravenous drip of acyclovir, and those in the observation group were treated with inhalation of recombinant human interferon α1b in addition to the treatment in the control group. The two groups were compared in terms of clinical symptoms, immune function, inflammatory response, myocardial zymogram, and adverse reactions. RESULTS: Compared with the control group, the observation group had significantly shorter time to body temperature recovery and disappearance of isthmopyra, cervical lymph node enlargement, hepatomegaly, and splenomegaly (P<0.05). After treatment, both groups had significant increases in CD4, CD4/CD8, and CD19, and the observation group had significantly higher levels of these markers than the control group (P<0.05). After treatment, both groups had significant reductions in the levels of CD8+, tumor necrosis factor-α, interlukin-6, creatine kinase, and creatine kinase-MB, and the treatment group had significantly lower levels of these markers than the control group (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the two groups after treatment (P>0.05). CONCLUSIONS For children with IM, recombinant human interferon α1b assisting acyclovir can effectively improve immune function, inhibit inflammatory reaction, reduce myocardial injury, and thus alleviate clinical symptoms.
Antigens, CD19 ; Hepatomegaly ; Humans ; Infectious Mononucleosis ; Prospective Studies ; Splenomegaly

Epstein-Barr virus (EBV) is the cause of infectious mononucleosis, which is characterized by fever, lymphadenopathy, and sore throat. On the other hand, gastrointestinal symptoms of EBV infection like dyspepsia, abdominal pain are non-specific and rarely encountered, which means it is difficult to diagnose gastric involvement of EBV infection without suspicion. The relation between gastric carcinoma and gastric lymphoma associated with EBV infection is well defined, but relations with other EBV-associated gastrointestinal diseases such as gastritis and peptic ulcer disease have rarely been reported. We report a case of benign gastric ulcer with EBV infection confirmed by endoscopic and histological findings.
Abdominal Pain ; Dyspepsia ; Epstein-Barr Virus Infections ; Fever ; Gastritis ; Gastrointestinal Diseases ; Hand ; Helicobacter pylori ; Herpesvirus 4, Human ; In Situ Hybridization ; Infectious Mononucleosis ; Lymphatic Diseases ; Lymphoma ; Peptic Ulcer ; Pharyngitis ; Stomach Ulcer

Chronic active Epstein-Barr virus (CAEBV) infection is characterized by recurrent infectious mononucleosis (IM)-like symptoms and an unusual pattern of anti-EBV antibodies. We report a boy with CAEBV who progressed to aggressive hemophagocytic lymphohistiocytosis (HLH) with NK cell neoplasm. A 19-year-old adolescent boy was admitted with fever and a history of recurrent IM-like symptoms following mosquito bites since the age of 6 years. His condition was diagnosed as CAEBV with atypical lymphocytosis and an unusual pattern of anti-EBV antibodies. His symptoms subsided during treatment with steroids and cyclosporine, although the EBV genome load kept increasing for several years. He was re-admitted after follow-up loss for 8 years, and his clinical and laboratory findings confirmed HLH and high titer of the EBV genome. Bone marrow analysis with flow cytometry showed hemophagocytosis with compatible NK cell neoplasm. He rapidly progressed to pulmonary infection and expired soon after. We conclude that hematopoietic stem cell transplantation may be a potential therapeutic modality for treating CAEBV before serious EBV manifestations.
Adolescent ; Antibodies ; Bone Marrow ; Culicidae ; Cyclosporine ; Epstein-Barr Virus Infections ; Fever ; Flow Cytometry ; Follow-Up Studies ; Genome ; Hematopoietic Stem Cell Transplantation ; Herpesvirus 4, Human ; Humans ; Hypersensitivity ; Infectious Mononucleosis ; Killer Cells, Natural ; Lymphocytosis ; Lymphohistiocytosis, Hemophagocytic ; Male ; Steroids ; Young Adult

A 19-year-old otherwise healthy male presented to the Emergency Department with left upper quadrant abdominal pain having felt a “pop” in his abdomen which was followed by nausea and lightheadedness. There was no evidence of trauma but 3 weeks earlier he began with symptoms of a sore throat and nasal congestion without cough. On subsequent investigation, given the patient's acute abdominal pain, abnormal vitals and a non-diagnostic computed tomography scan, an emergent exploratory laparotomy was performed. There was 600 mL of blood evacuated from the abdomen. A 643-gram inflamed and ruptured spleen was identified and removed, and follow-up lab work was positive for heterophile antibody. This report describes spontaneous splenic rupture caused by infectious mononucleosis and compares characteristics of traumatic versus non-traumatic cases.
Abdomen ; Abdominal Pain ; Cough ; Dizziness ; Emergency Service, Hospital ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Herpesvirus 4, Human ; Humans ; Infectious Mononucleosis ; Laparotomy ; Male ; Nausea ; Pharyngitis ; Spleen ; Splenectomy ; Splenic Rupture ; Young Adult

PURPOSE: To report a case of Roth spots, panuveitis, and infectious mononucleosis in a healthy adult. CASE SUMMARY: An immunocompetent 30-year-old male visited our clinic complaining of reduced visual acuity and a floating sense in both eyes of 2 days. He had experienced flu-like symptoms including fever, sore throat, myalgia, and malaise for 10 days before visual acuity decreased. His best-corrected visual acuity was 20/25 in both eyes and inflammatory cells were found in both the anterior chambers and the vitreous. Funduscopy revealed multiple retinal hemorrhages and Roth spots in both eyes. We prescribed topical steroid eye drops. A peripheral blood test revealed mild leukocytosis with lymphocytosis (60%) consisted of atypical lymphocyte (7%). Serologic examinations were positive for cytomegalovirus (CMV) immunoglobulin M (IgM) Ab and Epstein-Barr virus IgM Ab. A polymerase chain reaction for blood CMV was positive. The presumptive clinical diagnosis was Roth spots and panuveitis associated with infectious mononucleosis. Three weeks later, no inflammatory cells were apparent in the anterior chamber or vitreous. Best-corrected visual acuity had recovered to 20/20 in both eyes, and the retinal hemorrhage had completely disappeared. CONCLUSIONS: Roth spots and panuveitis can be present in patients with infectious mononucleosis, which should thus be included in the differential diagnosis of Roth spots.
Adult ; Anterior Chamber ; Cytomegalovirus ; Diagnosis ; Diagnosis, Differential ; Fever ; Hematologic Tests ; Herpesvirus 4, Human ; Humans ; Immunoglobulin M ; Infectious Mononucleosis ; Leukocytosis ; Lymphocytes ; Lymphocytosis ; Male ; Myalgia ; Ophthalmic Solutions ; Panuveitis ; Pharyngitis ; Polymerase Chain Reaction ; Retinal Hemorrhage ; Uveitis ; Visual Acuity

Epstein-Barr virus (EBV) infection can be presented with various clinical manifestations and different levels of severity when infected. Infectious mononucleosis, which is most commonly caused by EBV infection in children and adolescents, is a clinical syndrome characterized by fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. But rarely, patients with infectious mononucleosis may present with gastrointestinal symptoms and complicated by gastritis, splenic infarction, and splenic rupture. We encountered a 16-year-old girl who presented with fever, fatigue, and epigastric pain. Splenic infarction and EBV-associated gastritis were diagnosed by using esophagogastroduodenoscopy and abdominal computed tomography. Endoscopy revealed a generalized hyperemic nodular lesion in the stomach, and the biopsy findings were chronic gastritis with erosion and positive in situ hybridization for EBV. As splenic infarction and acute gastritis are rare in infectious mononucleosis and are prone to be overlooked, we must consider these complications when an infectious mononucleosis patient presents with gastrointestinal symptom.
Adolescent ; Biopsy ; Child ; Endoscopy ; Endoscopy, Digestive System ; Epstein-Barr Virus Infections ; Fatigue ; Female ; Fever ; Gastritis* ; Herpesvirus 4, Human* ; Humans ; In Situ Hybridization ; Infectious Mononucleosis ; Lymphatic Diseases ; Pharyngitis ; Splenic Infarction* ; Splenic Rupture ; Stomach

OBJECTIVETo investigate the diagnostic value of combined detection of HLA-G and IL-6 in children with infectious mononucleosis (IM).

METHODSEighty-three children suffered from infectious mononucleosis hospitalized in Wuhan Children's Hospital（Wuhan Maternal and Child Healthcare Hospital） from January 2014 to June 2017 were selected as the IM group, 83 healthy children in the same period were selected as the as control group. Enzyme-linked in munosorbent assay (ELISA) was used to detect and compare the changes of HLA-G and IL-6 levels between 2 groups. The positive rate of HLA-G and IL-6 were calculated and compared. The correlation of plasma HLA-G with IL-6 in IM group was analyzed, the MOC curve was drawn, and the diagnostic efficiencies of plasma HLA-G and IL-60 alone as well as 2 combined detection were compared.

RESULTSThe plasma level of HLA-G and IL-6 in IM group was significantly higher than that in control group, and the difference between the 2 groups was were statistically significant (P<0.01). In untreated children with infectious mononucleosis, the positive rate of plasma HLA-G detection was 90.36% (75/83) and the positive rate of IL-6 detection was 87.95% (73/83) without a significant difference between 2 groups (P>0.05). There was a positive correlation between the plasma HLA-G and IL-6 levels in the observation group (r=0.196, (P<0.05). The analysis of ROC curve diagnostic effectiveness showed that the diagnostic sensitivity of IL-6 was 68.90%, the specificity was 71.50%, and the area under the ROC curve was 0.703. The diagnostic sensitivity of the plasma HLA-G was 74.20%, the specificity was 77.50%, and the area under the ROC curve was 0.761. The combined diagnostic sensitivity and specificity of 2 methods was 89.50% and 85.70% respectively, and the area under the ROC curve was 0.906.

CONCLUSIONThe combination of HLA-G and IL-6 for detect infectious mononucleosis resulted in a high sensitivity and accuracy, which is helpful to define the progress of the patient's condition, and worth for clinical application.