J Korean Med Sci.  2007 Sep;22(Suppl):S167-S170. 10.3346/jkms.2007.22.S.S167.

Persistent Anemia in a Patient with Diffuse Large B Cell Lymphoma: Pure Red Cell Aplasia Associated with Latent Epstein-Barr Virus Infection in Bone Marrow

• Sung HJ
• Kim SJ
• Lee JH
• Lee G
• Lee KA
• Choi CW
• Kim BS
• Kim JS

• KMID: 1785809
• DOI: http://doi.org/10.3346/jkms.2007.22.S.S167

Abstract

We report a case of pure red cell aplasia (PRCA), which was initially suspected as a result of bone marrow involvement of diffuse large B cell lymphoma. Persistent anemia without an obvious cause was observed in a 47-yr-old man diagnosed with relapsed diffuse large B cell lymphoma. The bone marrow study showed only erythroid hypoplasia without the evidence of bone marrow involvement with lymphoma cells, thus PRCA was suggested. However, parvovirus infection was excluded as a potential cause of PRCA because of negative IgM anti-parvovirus B19 antibody and negative parvovirus PCR in the serum. Latent Epstein-Barr virus (EBV) infection of bone marrow was suggested by in situ hybridization with EBV-encoded small RNA (EBER) that showed a strong positive expression in bone marrow cells. Thus, PRCA was thought to be associated with latent EBV infection in bone marrow cells. Although the finding of unexplained anemia is a possible predictor of bone marrow involvement with lymphoma cells, PRCA as a result of a viral infection including EBV should be considered in lymphoma patients. This is the first report of the occurrence of PRCA associated with latent EBV infection in a patient with non-Hodgkin's lymphoma.

Keyword

Red-Cell Aplasia; Epstein-Barr Virus; Lymphoma

MeSH Terms

Adult
Bone Marrow/pathology
Bone Marrow Diseases/*complications/diagnosis/pathology
Bone Marrow Neoplasms/pathology
Diagnosis, Differential
Epstein-Barr Virus Infections/*complications/diagnosis
Humans
Lymphoma, Large B-Cell, Diffuse/*complications/pathology
Male
Red-Cell Aplasia, Pure/diagnosis/*etiology

Figure

• 

  Fig. 1 Bone marrow aspirate smear (Wright-Giemsa stain, ×400). Marrow cellularity is decreased for the patient's age and severe paucity of erythroid cells is observed. However, myeloid and megakaryocytic lineage is intact.

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  Fig. 2 Bone marrow biopsy section (Hematoxylin & eosin stain, ×100). Marrow cellularity is decrased; however, there was no evidence of marrow infiltration of lymphoma cells.

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  Fig. 3 In situ hybridization with Epstein-Barr virus (EBV)-encoded small RNA (EBER) showed positive expression in bone marrow cells, which suggested latent EBV infection in bone marrow.

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