Case Report
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Year 2020, Volume: 37 Issue: 4, 143 - 147, 11.09.2020

Abstract

References

  • 1. Young N. S., Calado R. T., Scheinberg P. Current concepts in the pathophysiology and treatment of aplastic anemia. Blood. 2006;108(8):2509–2519.
  • 2. Takahashi T, Maruyama Y, Saitoh M, Itoh H, Yoshimoto M, Tsujisaki M. Fatal Epstein-Barr Virus Reactivation in an Acquired Aplastic Anemia Patient Treated with Rabbit Antithymocyte Globulin and Cyclosporine A. Case Rep Hematol. 2015;2015:926874.
  • 3. Stanfield BA, Luftig MA. Recent advances in understanding Epstein-Barr virus. F1000Res. 2017;6:386.
  • 4. Ok CY, Li L, Young KH. EBV-driven B-cell lymphoproliferative disorders: from biology, classification and differential diagnosis to clinical management. Exp Mol Med. 2015;47(1):e132.
  • 5. van Esser J. W. J., van der Holt B., Meijer E., et al. Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell-depleted SCT. Blood. 2001;98(4):972–978.
  • 6. Scheinberg P., Fischer S. H., Li L., et al. Distinct EBV and CMV reactivation patterns following antibody-based immunosuppressive regimens in patients with severe aplastic anemia. Blood. 2007;109(8):3219–3224.
  • 7. Patel KR, Bertuch A, Sasa GS, Himes RW, Wu H. Features of hepatitis in hepatitis-associated aplastic anemia: Clinical and histopathologic study J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):e7-e12.
  • 8. Khurana A Dasanu CA. Hepatitis associated aplastic anemia: case report and discussion. Conn Med. 2014 Sep;78(8):493-5.
  • 9. Ishimura M, Ohga S, Ichiyama M, Kusuhara K, Takada H, Hara T et al. Hepatitis-associated aplastic anemia during a primary infection of genotype 1a torque teno virus. European Journal of Pediatrics. 2010 Jul 1;169(7):899-902.
  • 10. Schenke C, Alejandre-Alcázar MA, Holter W, Korn K, Papadopoulos T, Köhler H. Aplastic anemia following hepatitis associated with human herpesvirus 6. J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):527-9.
  • 11. Mashima K, Yano S, Yokoyama H, et al. Epstein-Barr Virus-associated Lymphoproliferative Disorder with Encephalitis Following Anti-thymocyte Globulin for Aplastic Anemia Resolved with Rituximab Therapy: A Case Report and Literature Review. Intern Med. 2017;56(6):701–706.
  • 12. Zhang T, Liu C, Liu H, Li L, Wang T, Fu R. Epstein Barr Virus Infection Affects Function of Cytotoxic T Lymphocytes in Patients with Severe Aplastic Anemia. Biomed Res Int. 2018;2018:6413815.
  • 13. Lazarus KH, Baehner RL. Aplastic anemia complicating infectious mononucleosis: a case report and review of the literature. Pediatrics. 1981;67:907–910.
  • 14. Anderlini P, Riggs SA, Korbling M, Champlin R. Syngeneic blood stem cell transplantation for infectious mononucleosis-related aplastic anaemia. Br J Haematol 1999;106(1):159–161.
  • 15. Purtilo DT, Sakamoto K, Barnabei V. Epstein-Barr virus-induced diseases in boys with the X-linked lymphoproliferative syndrome (XLP): update on studies of the registry. Am J Med, 1982;73:49–56.
  • 16. Cabot RC, Scully RE, Mark EJ, McNeely BU. Case records of the Massachusetts General Hospital. Case 31-1984. N Engl J Med 1984; 311:314–322.
  • 17. Grishaber JE, McClain KL, Mahoney DH Jr, Fernbach DJ. Successful outcome of severe aplastic anemia following Epstein-Barr virus infection. Am J Hematol 1988;28:273–275.
  • 18. Shadduck RK, Winkelstein A, Zeigler Z, et al. Aplastic anemia following infectious mononucleosis: possible immune etiology. Exp Hematol 1979;7:264–271.
  • 19. Ahronheim GA, Auger F, Joncas JH, Ghibu F, Rivard G-E, Rab-Traub N. Primary infection by Epstein-Barr virus presenting as aplastic anemia. N Engl J Med 1983;309:313–314.
  • 20. Swerdlow S. H., Webber S. A., Chadburn A., Ferry J. A. Post-transplant lymphoproliferative disorders. In: Swerdlow S. H., Campo E., Harris N. L., et al., editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2008. pp. 343–349.

Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge

Year 2020, Volume: 37 Issue: 4, 143 - 147, 11.09.2020

Abstract

Background: Acquired aplastic anemia is an unusual disease associated with pancytopenia characterized by hypocellular bone marrow. Aplastic anemia is an auto-immune disorder wherein patients would show a antithymocyte globulin (ATG)- induced hematological response after T-cell reduction. The combination of cyclosporine A and ATG as immunosuppressive therapy is considered as the standard treatment approach for patients with aplastic anemia. EBV infection in a patient with aplastic anemia is an unusual clinical presentation.
Case Report: A 49-year-old Asian female presented to our hospital with dizziness and fatigue. The patient’s platelet count was extremely low. A hypocellular marrow with lymphocytosis was observed with the help of a bone marrow aspirate and biopsy. The patient was given cyclosporine and eltrombopag as a bridge to primary therapy, i.e. antithymocyte globulin (ATG)/allogenic transplant considering she had pancytopenia. The patient developed platelet refractoriness. Epstein-Barr virus polymerase chain reaction (PCR) was performed, considering the patient’s atypical presentation. As per the results, it was significantly positive with 2250 copies/ul. A diagnosis of aplastic anemia with EBV infection was made.

References

  • 1. Young N. S., Calado R. T., Scheinberg P. Current concepts in the pathophysiology and treatment of aplastic anemia. Blood. 2006;108(8):2509–2519.
  • 2. Takahashi T, Maruyama Y, Saitoh M, Itoh H, Yoshimoto M, Tsujisaki M. Fatal Epstein-Barr Virus Reactivation in an Acquired Aplastic Anemia Patient Treated with Rabbit Antithymocyte Globulin and Cyclosporine A. Case Rep Hematol. 2015;2015:926874.
  • 3. Stanfield BA, Luftig MA. Recent advances in understanding Epstein-Barr virus. F1000Res. 2017;6:386.
  • 4. Ok CY, Li L, Young KH. EBV-driven B-cell lymphoproliferative disorders: from biology, classification and differential diagnosis to clinical management. Exp Mol Med. 2015;47(1):e132.
  • 5. van Esser J. W. J., van der Holt B., Meijer E., et al. Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell-depleted SCT. Blood. 2001;98(4):972–978.
  • 6. Scheinberg P., Fischer S. H., Li L., et al. Distinct EBV and CMV reactivation patterns following antibody-based immunosuppressive regimens in patients with severe aplastic anemia. Blood. 2007;109(8):3219–3224.
  • 7. Patel KR, Bertuch A, Sasa GS, Himes RW, Wu H. Features of hepatitis in hepatitis-associated aplastic anemia: Clinical and histopathologic study J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):e7-e12.
  • 8. Khurana A Dasanu CA. Hepatitis associated aplastic anemia: case report and discussion. Conn Med. 2014 Sep;78(8):493-5.
  • 9. Ishimura M, Ohga S, Ichiyama M, Kusuhara K, Takada H, Hara T et al. Hepatitis-associated aplastic anemia during a primary infection of genotype 1a torque teno virus. European Journal of Pediatrics. 2010 Jul 1;169(7):899-902.
  • 10. Schenke C, Alejandre-Alcázar MA, Holter W, Korn K, Papadopoulos T, Köhler H. Aplastic anemia following hepatitis associated with human herpesvirus 6. J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):527-9.
  • 11. Mashima K, Yano S, Yokoyama H, et al. Epstein-Barr Virus-associated Lymphoproliferative Disorder with Encephalitis Following Anti-thymocyte Globulin for Aplastic Anemia Resolved with Rituximab Therapy: A Case Report and Literature Review. Intern Med. 2017;56(6):701–706.
  • 12. Zhang T, Liu C, Liu H, Li L, Wang T, Fu R. Epstein Barr Virus Infection Affects Function of Cytotoxic T Lymphocytes in Patients with Severe Aplastic Anemia. Biomed Res Int. 2018;2018:6413815.
  • 13. Lazarus KH, Baehner RL. Aplastic anemia complicating infectious mononucleosis: a case report and review of the literature. Pediatrics. 1981;67:907–910.
  • 14. Anderlini P, Riggs SA, Korbling M, Champlin R. Syngeneic blood stem cell transplantation for infectious mononucleosis-related aplastic anaemia. Br J Haematol 1999;106(1):159–161.
  • 15. Purtilo DT, Sakamoto K, Barnabei V. Epstein-Barr virus-induced diseases in boys with the X-linked lymphoproliferative syndrome (XLP): update on studies of the registry. Am J Med, 1982;73:49–56.
  • 16. Cabot RC, Scully RE, Mark EJ, McNeely BU. Case records of the Massachusetts General Hospital. Case 31-1984. N Engl J Med 1984; 311:314–322.
  • 17. Grishaber JE, McClain KL, Mahoney DH Jr, Fernbach DJ. Successful outcome of severe aplastic anemia following Epstein-Barr virus infection. Am J Hematol 1988;28:273–275.
  • 18. Shadduck RK, Winkelstein A, Zeigler Z, et al. Aplastic anemia following infectious mononucleosis: possible immune etiology. Exp Hematol 1979;7:264–271.
  • 19. Ahronheim GA, Auger F, Joncas JH, Ghibu F, Rivard G-E, Rab-Traub N. Primary infection by Epstein-Barr virus presenting as aplastic anemia. N Engl J Med 1983;309:313–314.
  • 20. Swerdlow S. H., Webber S. A., Chadburn A., Ferry J. A. Post-transplant lymphoproliferative disorders. In: Swerdlow S. H., Campo E., Harris N. L., et al., editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2008. pp. 343–349.
There are 20 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Case Report
Authors

Nilesh Wasekar This is me

Girish Badarkhe This is me

Samadhan Pawar This is me

Chaitanya Borde This is me

Yasam Venkata Ramesh 0000-0002-4288-1120

Raj Nagarkar This is me

Publication Date September 11, 2020
Submission Date March 26, 2020
Acceptance Date April 29, 2020
Published in Issue Year 2020 Volume: 37 Issue: 4

Cite

APA Wasekar, N., Badarkhe, G., Pawar, S., Borde, C., et al. (2020). Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge. Journal of Experimental and Clinical Medicine, 37(4), 143-147.
AMA Wasekar N, Badarkhe G, Pawar S, Borde C, Ramesh YV, Nagarkar R. Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge. J. Exp. Clin. Med. September 2020;37(4):143-147.
Chicago Wasekar, Nilesh, Girish Badarkhe, Samadhan Pawar, Chaitanya Borde, Yasam Venkata Ramesh, and Raj Nagarkar. “Reactivation of Epstein–Barr Virus in Aplastic Anemia: A Clinical Challenge”. Journal of Experimental and Clinical Medicine 37, no. 4 (September 2020): 143-47.
EndNote Wasekar N, Badarkhe G, Pawar S, Borde C, Ramesh YV, Nagarkar R (September 1, 2020) Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge. Journal of Experimental and Clinical Medicine 37 4 143–147.
IEEE N. Wasekar, G. Badarkhe, S. Pawar, C. Borde, Y. V. Ramesh, and R. Nagarkar, “Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge”, J. Exp. Clin. Med., vol. 37, no. 4, pp. 143–147, 2020.
ISNAD Wasekar, Nilesh et al. “Reactivation of Epstein–Barr Virus in Aplastic Anemia: A Clinical Challenge”. Journal of Experimental and Clinical Medicine 37/4 (September 2020), 143-147.
JAMA Wasekar N, Badarkhe G, Pawar S, Borde C, Ramesh YV, Nagarkar R. Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge. J. Exp. Clin. Med. 2020;37:143–147.
MLA Wasekar, Nilesh et al. “Reactivation of Epstein–Barr Virus in Aplastic Anemia: A Clinical Challenge”. Journal of Experimental and Clinical Medicine, vol. 37, no. 4, 2020, pp. 143-7.
Vancouver Wasekar N, Badarkhe G, Pawar S, Borde C, Ramesh YV, Nagarkar R. Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge. J. Exp. Clin. Med. 2020;37(4):143-7.