J Med Cases

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

Journal website http://www.journalmc.org

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

Figures

Figure 1. Chest radiograph on admission showing consolidation of the bilateral lungs.

Figure 2. Chest computed tomography scan showing multiple patchy consolidation and nodules in both lungs.

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. 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

**Table 1.** Laboratory Data on Admission
Hematology		Biochemistry		Serology
Abbreviations: sIL-2R, soluble interleukin-2 receptor.
WBC	13,100/µL	Alb	3.0 g/dL	CRP	2.78 mg/dL
Myelo	1.0%	BUN	33.1 g/dL	IgG	756 mg/dL
Stab	1.5%	Cr	1.23 mg/dL	IgA	307 mg/dL
Seg	69.5%	T-Bil	0.6 mg/dL	IgM	89 mg/dL
Eosino	0.5%	ALP	312 U/L	Cyclosporine	54.4 ng/mL
Ly	17.0%	LDH	272 U/L	sIL-2R	6040 U/mL
Mono	10.5%	AST	17 U/L
RBC	339 × 10⁴/mL	ALT	13 U/L	Arterial blood gas analysis (FiO₂ 0.24)
Hb	9.9 g/dL	γ-GTP	83 U/L	pH	7.450
Hct	29.0%	CK	23 U/L	PaCO₂	33.3 mmHg
Plt	25.5 × 10⁴/mL	Ca	8.8 mg/dL	PaO₂	70.8 mmHg
		Na	135 mEq/L	HCO₃^-	22.8 mEq/L
		K	4.3 mEq/L	Lactate	1.0 mmol/L
		Cl	101 mEq/L
		Glu	187 mg/dL
		β-D glucan	5.7 pg/mL