Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 5, Number 5, May 2014, pages 279-282

Epstein-Barr Virus-Related Lymphoproliferative Disorder Caused by the Use of Antithymocyte Globulin and Cyclosporine for Aplastic Anemia


Figure 1.
Figure 1. Chest radiograph on admission showing consolidation of the bilateral lungs.
Figure 2.
Figure 2. Chest computed tomography scan showing multiple patchy consolidation and nodules in both lungs.
Figure 3.
Figure 3. Lung biopsy. (a) Hematoxylin-eosin (HE) stain (× 40) shows large, blastic, atypical lymphoid cells. (b) Most cells are strongly stained for CD20. (c) Epstein-Barr virus (EBV)-encoded RNA in situ hybridization shows the presence of EBV in lymphoid cells. (d) Nuclear Ki-67 staining shows a high Ki-67 labeling index (over 80%).
Figure 4.
Figure 4. Chest radiographs showing consolidation of lungs was decreased by the cessation of cyclosporine. (a) Before discontinuation of cyclosporine. (b) Fourteen days after discontinuation of cyclosporine.


Table 1. Laboratory Data on Admission
Abbreviations: sIL-2R, soluble interleukin-2 receptor.
WBC13,100/µLAlb3.0 g/dLCRP2.78 mg/dL
Myelo1.0%BUN33.1 g/dLIgG756 mg/dL
Stab1.5%Cr1.23 mg/dLIgA307 mg/dL
Seg69.5%T-Bil0.6 mg/dLIgM89 mg/dL
Eosino0.5%ALP312 U/LCyclosporine54.4 ng/mL
Ly17.0%LDH272 U/LsIL-2R6040 U/mL
Mono10.5%AST17 U/L
RBC339 × 104/mLALT13 U/LArterial blood gas analysis (FiO2 0.24)
Hb9.9 g/dLγ-GTP83 U/LpH7.450
Hct29.0%CK23 U/LPaCO233.3 mmHg
Plt25.5 × 104/mLCa8.8 mg/dLPaO270.8 mmHg
Na135 mEq/LHCO3-22.8 mEq/L
K4.3 mEq/LLactate1.0 mmol/L
Cl101 mEq/L
Glu187 mg/dL
β-D glucan5.7 pg/mL