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

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

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

B-Lymphocytes ; Bone Neoplasms ; Humans ; Lumbar Vertebrae ; Lymphocytosis ; Plasmacytoma

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

PURPOSE: This report describes the results of a survey of the characteristics of pertussis in children from a single institution and compares it to data from the Korea Centers of Disease Control (KCDC). METHODS: We retrospectively evaluated the medical records of 17 and 6 patients diagnosed with pertussis and parapertussis, respectively, at Soonchunhyang University Bucheon Hospital from January 2005 to January 2017. RESULTS: Of the 17 patients with pertussis, 9 were under 1 year of age (52.9%), 3 were aged between 1 and 10 years (17.6%), and 5 were over 10 years of age (29.4%). Seven patients (41.2%) had never received diphtheria-tetanus-acellular pertussis vaccines, of which 5 were infants below 2 months of age and 2 were 10 years old and lived in China. Four patients showed the initial symptoms of cough in China. The sources of infection were the parents (2 cases) and the siblings (8 cases). All patients showed prolonged severe cough and the average duration of cough was 26 days. Severe symptoms, including dyspnea, cyanosis, apnea, and seizures, were observed in the children under 2 months of age. According to the recent 10-year KCDC data, the highest rate of pertussis diagnosis was noted in infants (47.8%), followed by adolescents (18.7%). Six patients with parapertussis also presented with prolonged severe cough without any other severe symptoms. Lymphocytosis was not found, unlike the patients with pertussis. CONCLUSION: The possibility of pertussis and parapertussis should be considered among patients with prolonged severe cough, especially in infants and adolescents.
Adolescent ; Apnea ; Bordetella parapertussis ; Bordetella pertussis ; Child ; China ; Cough ; Cyanosis ; Diagnosis ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Dyspnea ; Gyeonggi-do ; Humans ; Infant ; Korea ; Lymphocytosis ; Medical Records ; Parents ; Retrospective Studies ; Seizures ; Siblings ; Whooping Cough

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, medication-induced hypersensitivity reaction with long latency. It is characterized by fever, rash, leukocytosis with eosinophilia, atypical lymphocytosis, and internal organ involvement. The most common causes of DRESS syndrome are sulfonamides and anticonvulsants such as carbamazepine and lamotrigine. However, valproic acid and olanzapine could develop DRESS syndrome. We report a case of DRESS syndrome associated with valproic acid and olanzapine in a 41 years old male patient with bipolar disorder.
Anticonvulsants ; Bipolar Disorder* ; Carbamazepine ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Exanthema* ; Fever ; Humans ; Hypersensitivity ; Leukocytosis ; Lymphocytosis ; Male ; Sulfonamides ; Valproic Acid*

BACKGROUND: Acute viral gastroenteritis is a common illness in young children. Rotavirus, norovirus and enteric adenovirus are the major agents for viral gastroenteritis. Their detection rates have gradually increased in Korea. Our aim was to monitor the epidemiologic characteristics of the aforementioned viruses and to determine the laboratory and clinical characteristics of pediatric patients infected with these viruses. METHODS: From December 2009 to November 2010, 685 stool specimens from patients hospitalized at Chung-Ang University Hospital were tested for the aforementioned viruses using multiplex PCR. A corresponding medical record review was retrospectively conducted. RESULTS: The overall prevalence rate was 44.8%, with rates of 16.3%, 1.9%, 22.7%, 3.1%, and 0.8% for rotavirus, norovirus genogroup I, norovirus genogroup II, enteric adenovirus, and astrovirus, respectively. Mixed virus infections were detected in 37 patients (5.4%). The highest incidence rates occurred in March 2010 (18.9%), in the 13-24 month age group (38.1%), and in males (53.1%). Fever and chills were most frequently observed in patients with adenovirus (44.4%) than other viruses, while diarrhea was most frequently observed in patients with rotavirus (93.7%). Leukocytosis (55.0%) and lymphocytosis (21.0%) were more common in the norovirus-infected group than other viruses-infected group. CONCLUSION: Our results show different prevalence rates and clinical findings for each gastroenteritis-associated virus. To better understand the clinico-epidemiological features observed in this study, further epidemiologic and clinical investigations are needed.
Adenoviridae ; Child ; Chills ; Diarrhea ; Epidemiology ; Fever ; Gastroenteritis* ; Genotype ; Humans ; Incidence ; Korea ; Leukocytosis ; Lymphocytosis ; Male ; Medical Records ; Multiplex Polymerase Chain Reaction ; Norovirus ; Pediatrics ; Polymerase Chain Reaction ; Prevalence ; Retrospective Studies ; Rotavirus ; Tertiary Healthcare*

Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.
Acute Generalized Exanthematous Pustulosis* ; Anti-Bacterial Agents ; beta-Lactamases ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Exanthema* ; Fever ; Humans ; Hypersensitivity* ; Lymphocytosis ; Piperacillin ; Prognosis ; Sodium

No abstract available.
Child, Preschool ; Female ; Flow Cytometry ; Humans ; Hydroa Vacciniforme/*diagnosis/pathology ; Immunophenotyping ; Lymphocytosis/complications ; Lymphoma/*diagnosis ; Receptors, Antigen, T-Cell, gamma-delta/genetics/*metabolism ; STAT3 Transcription Factor/genetics/metabolism ; Sequence Analysis, DNA ; Skin/metabolism ; T-Lymphocytes/*metabolism