Infectious Mononucleosis Mimicking Acute Lymphoblastic Leukemia (ALL): ACase Report
,
Abstract
Infectious mononucleosis (IM), usually caused by Epstein-Barr virus (EBV), is not rare among
populations. Fever, pharyngotonsilitis and lymphadenopathy are its major presentations. Since
EBV mainly targets lymphomononuclear cells and the reticuloendothelial system, it might be
mistaken with hematological malignancies. The case presented in this article showed a very high
similarity to an acute lymphoblastic leukemia, which complicated the diagnostic work-up. The
histopathological data and clinical course of IM patients are not usually distinctive; hence, early
work-up for EBV-associated IM is suggested.
[1]Ressing ME, van Gent M, Gram AM, Hooykaas MJG, Piersma SJ, Wiertz EJHJ. Immune evasion by Epstein-Barr virus. Curr Top Microbiol Immunol [Internet]. 2015; 391:355–81. Available from: http://dx.doi.org/10.1007/978-3-319-22834-1_12
[2]Sulik A, Oldak E, Kroten A, Lipska A, Radziwon P. Epstein-Barr virus effect on frequency of functionally distinct T cell subsets in children with infectious mononucleosis. Adv Med Sci [Internet]. 2014;59(2):227–31. Available from: http://dx.doi.org/10.1016/j.advms.2014.04.003
[3]Quintanilla-Martinez L, Kumar S, Fend F, Reyes E, Teruya-Feldstein J, Kingma DW, et al. Fulminant EBV (+) T-cell lymphoproliferative disorder following acute/chronic EBV infection: a distinct clinicopathologic syndrome. Blood. 2000;96(2):443–51.
[4]Borer A, Gilad J, Haikin H, Riesenberg K, Porath A, Schlaeffer F. Clinical features and costs of care for hospitalized adults with primary EpsteinBarr virus infection. Am J Med [Internet]. 1999;107(2):144–8. Available from: http://dx.doi.org/10.1016/s0002-9343(99)00194-1
[5]Dunmire SK, Hogquist KA, Balfour HH. Infectious mononucleosis. Curr Top Microbiol Immunol [Internet]. 2015;390(Pt 1):211–40. Available from: http://dx.doi.org/10.1007/978-3-319-22822-8_9
[6]González Saldaña N, Monroy Colín VA, Piña Ruiz G, Juárez Olguín H. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children. BMC Res Notes [Internet]. 2012;5(1):361. Available from: http://dx.doi.org/10.1186/1756-0500-5- 361
[7]Shiftan TA, Mendelsohn J. The circulating “atypical” lymphocyte. Hum Pathol [Internet]. 1978;9(1):51–61. Available from: http://dx.doi.org/10.1016/s0046-8177(78)80007-0
[8]Karzon DT. Infectious mononucleosis. Advances in Pediatrics. 1976; 22:231–65.
[9]Pattengale PK, Smith RW, Perlin E. Atypical lymphocytes in acute infectious mononucleosis: Identification by multiple T and B lymphocyte markers. N Engl J Med [Internet]. 1974;291(22):1145–8. Available from: http://dx.doi.org/10.1056/nejm197411282912201
[10] Preti HA, Huh YO, O’Brien SM, Andreeff M, Pierce ST, Keating M, et al. Myeloid markers in adult acute lymphocytic leukemia. Correlations with patient and disease characteristics and with prognosis. Cancer [Internet]. 1995;76(9):1564–70. Available from: http://dx.doi.org/10.1002/1097-0142(19951101)76:9<1564::aidcncr2820760911>3.0.co;2-1
[11] Levine PH, Stevens DA, Coccia PF, Dabich L, Roland A. Infectious mononucleosis prior to acute leukemia: a possible role for the Epstein-Barr virus. Cancer [Internet]. 1972;30(4):875–80. Available from: http://dx.doi.org/10.1002/1097 0142(197210)30:4<875::aidcncr2820300402>3.0.co;2-n
[12] Deardorff WL, Gerber P, Vogler WR. Infectious mononucleosis in acute leukemia with rising Epstein-Barr virus antibody titers. Ann Intern Med [Internet]. 1970;72(2):235–40. Available from: http://dx.doi.org/10.7326/0003-4819-72-2-235
[13] Callan MF, Tan L, Annels N, Ogg GS, Wilson JD, O’Callaghan CA, et al. Direct visualization of antigen-specific CD8+ T cells during the primary immune response to Epstein-Barr virus In vivo. J Exp Med [Internet]. 1998;187(9):1395–402. Available from: http://dx.doi.org/10.1084/jem.187.9.1395
[14] Hosoi H, Sonoki T, Murata S, Mushino T, Kuriyama K, Nishikawa A, et al. Successful immunosuppressive therapy for severe infectious mononucleosis in a patient with clonal proliferation of EBV-infected CD8-positive cells. Intern Med [Internet]. 2015;54(12):1537–41. Available from: http://dx.doi.org/10.2169/internalmedicine.54.3201
[15] Chhabra P, Law AD, Sharma U, Suri V, Sachdeva MS, Kumari S, et al. Epstein-barr virus infection masquerading as acute leukemia: a report of two cases and review of literature. Indian J Hematol Blood Transfus [Internet]. 2014;30(1):26 8. Available from: http://dx.doi.org/10.1007/s12288-012-0207-2
[16] Bahethi R, Gray M, Salib C, Likhterov I. Lymphoma mimicking chronic active Epstein-Barr virus: A case report. Head Neck Pathol[Internet]. 2020;14(4):1028–31. Available from: http://dx.doi.org/10.1007/s12105-020-01154-y
[17] Tung Y, Jeng M, Yu T, Yen H, Wu K. Infectious Mononucleosis Mimicking Malignancy or Mumps in Febrile Children. Fu-Jen Journal of Medicine [Internet]. 2017 Sep 29;15(3):141–52. Available from: https://www.hyread.com.tw/hyreadnew/search_detail_new.jsp?dt
[2]Sulik A, Oldak E, Kroten A, Lipska A, Radziwon P. Epstein-Barr virus effect on frequency of functionally distinct T cell subsets in children with infectious mononucleosis. Adv Med Sci [Internet]. 2014;59(2):227–31. Available from: http://dx.doi.org/10.1016/j.advms.2014.04.003
[3]Quintanilla-Martinez L, Kumar S, Fend F, Reyes E, Teruya-Feldstein J, Kingma DW, et al. Fulminant EBV (+) T-cell lymphoproliferative disorder following acute/chronic EBV infection: a distinct clinicopathologic syndrome. Blood. 2000;96(2):443–51.
[4]Borer A, Gilad J, Haikin H, Riesenberg K, Porath A, Schlaeffer F. Clinical features and costs of care for hospitalized adults with primary EpsteinBarr virus infection. Am J Med [Internet]. 1999;107(2):144–8. Available from: http://dx.doi.org/10.1016/s0002-9343(99)00194-1
[5]Dunmire SK, Hogquist KA, Balfour HH. Infectious mononucleosis. Curr Top Microbiol Immunol [Internet]. 2015;390(Pt 1):211–40. Available from: http://dx.doi.org/10.1007/978-3-319-22822-8_9
[6]González Saldaña N, Monroy Colín VA, Piña Ruiz G, Juárez Olguín H. Clinical and laboratory characteristics of infectious mononucleosis by Epstein-Barr virus in Mexican children. BMC Res Notes [Internet]. 2012;5(1):361. Available from: http://dx.doi.org/10.1186/1756-0500-5- 361
[7]Shiftan TA, Mendelsohn J. The circulating “atypical” lymphocyte. Hum Pathol [Internet]. 1978;9(1):51–61. Available from: http://dx.doi.org/10.1016/s0046-8177(78)80007-0
[8]Karzon DT. Infectious mononucleosis. Advances in Pediatrics. 1976; 22:231–65.
[9]Pattengale PK, Smith RW, Perlin E. Atypical lymphocytes in acute infectious mononucleosis: Identification by multiple T and B lymphocyte markers. N Engl J Med [Internet]. 1974;291(22):1145–8. Available from: http://dx.doi.org/10.1056/nejm197411282912201
[10] Preti HA, Huh YO, O’Brien SM, Andreeff M, Pierce ST, Keating M, et al. Myeloid markers in adult acute lymphocytic leukemia. Correlations with patient and disease characteristics and with prognosis. Cancer [Internet]. 1995;76(9):1564–70. Available from: http://dx.doi.org/10.1002/1097-0142(19951101)76:9<1564::aidcncr2820760911>3.0.co;2-1
[11] Levine PH, Stevens DA, Coccia PF, Dabich L, Roland A. Infectious mononucleosis prior to acute leukemia: a possible role for the Epstein-Barr virus. Cancer [Internet]. 1972;30(4):875–80. Available from: http://dx.doi.org/10.1002/1097 0142(197210)30:4<875::aidcncr2820300402>3.0.co;2-n
[12] Deardorff WL, Gerber P, Vogler WR. Infectious mononucleosis in acute leukemia with rising Epstein-Barr virus antibody titers. Ann Intern Med [Internet]. 1970;72(2):235–40. Available from: http://dx.doi.org/10.7326/0003-4819-72-2-235
[13] Callan MF, Tan L, Annels N, Ogg GS, Wilson JD, O’Callaghan CA, et al. Direct visualization of antigen-specific CD8+ T cells during the primary immune response to Epstein-Barr virus In vivo. J Exp Med [Internet]. 1998;187(9):1395–402. Available from: http://dx.doi.org/10.1084/jem.187.9.1395
[14] Hosoi H, Sonoki T, Murata S, Mushino T, Kuriyama K, Nishikawa A, et al. Successful immunosuppressive therapy for severe infectious mononucleosis in a patient with clonal proliferation of EBV-infected CD8-positive cells. Intern Med [Internet]. 2015;54(12):1537–41. Available from: http://dx.doi.org/10.2169/internalmedicine.54.3201
[15] Chhabra P, Law AD, Sharma U, Suri V, Sachdeva MS, Kumari S, et al. Epstein-barr virus infection masquerading as acute leukemia: a report of two cases and review of literature. Indian J Hematol Blood Transfus [Internet]. 2014;30(1):26 8. Available from: http://dx.doi.org/10.1007/s12288-012-0207-2
[16] Bahethi R, Gray M, Salib C, Likhterov I. Lymphoma mimicking chronic active Epstein-Barr virus: A case report. Head Neck Pathol[Internet]. 2020;14(4):1028–31. Available from: http://dx.doi.org/10.1007/s12105-020-01154-y
[17] Tung Y, Jeng M, Yu T, Yen H, Wu K. Infectious Mononucleosis Mimicking Malignancy or Mumps in Febrile Children. Fu-Jen Journal of Medicine [Internet]. 2017 Sep 29;15(3):141–52. Available from: https://www.hyread.com.tw/hyreadnew/search_detail_new.jsp?dt
| Files | ||
| Issue | Vol 8 No 2 (2023): March-April | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v8i2.13556 | |
| Keywords | ||
| Lnfectious mononucleosis Acute iymphoblastic leukemia Epstein-bar virus | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Akhlaghi M, Kazemi K, Sobhani S. Infectious Mononucleosis Mimicking Acute Lymphoblastic Leukemia (ALL): ACase Report. CRCP. 2023;8(2):64-67.
