Authors: Norifumi Tsukamoto Hiroshi Handa Akihiko Yokohama Takeki Mitsui Takayuki Saitoh Hiromi Koiso Hideki Uchiumi Takumi Hoshino Masamitsu Karasawa Hirokazu Murakami Masaru Kojima Yoshihisa Nojima
Publish Date: 2011/12/17
Volume: 44, Issue: 4, Pages: 237-241
Abstract
We report a woman in her early thirties with a longterm history of systemic lupus erythematosus SLE and prednisolone administration who progressed to EpsteinBarr virus EBVpositive lymphoproliferative disorder LPD Treatment for SLE consisted of 1 mg/kg/ day prednisolone followed by 5 mg/day of maintenance therapy Lymph node biopsies were performed when the patient was in her early thirties midforties and late fifties Histologically the initial lymph node lesion was characterized by numerous enlarged coalescing lymphoid follicles The second biopsy showed effacement of the follicles and expansion of the paracortical area A polymorphous population of small to mediumsized lymphocytes plasma cells and immunoblasts had diffusely infiltrated the paracortical area In the third lymph node biopsy fibrous collagen bands divided the epithelioid cell granulomas into nodules There were numerous Hodgkin and ReedSternberg cells in the epithelioid cell granuloma In situ hybridization demonstrated there were no EBVinfected lymphocytes in the first biopsy however EBER+ cells were detected in the second and third biopsy specimens The current findings illustrate the natural progression in a patient with a longterm history of EBV+ Bcell LPD in which the immunodeficiency was caused by SLE and probably her aging which together resulted in histological change
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