Yusuke Ito1, Kensuke Takaoka1, Kazuhiro Toyama1, Kazuki Taoka1, Yoshitaka Wakabayashi2, Aya Shinozaki-Ushiku3, Aiko Okazaki2, Kinuyo Chikamatsu4, Satoshi Mitarai4, Tetsuo Ushiku3 and Mineo Kurokawa1,5.
1 Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo.
2 Department of Infectious Diseases, The University of Tokyo Hospital.
3 Department of Pathology, Graduate School of Medicine, The University of Tokyo.
4 Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association.
5 Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital.
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This is the first case of concurrent Mycobacterium genavense lymphadenitis and Epstein-Barr virus (EBV)-positive lymphoproliferative disorder (LPD) in the same lymph node with no immunocompromised history. M. genavense infection is a rare opportunistic infection mainly for human immunodeficiency virus (HIV)-infected patients. Although no immunodeficiency was detected in our patient, our case indicates that the immunodeficiency in the background of EBV latency type III and the immunosuppression by malignant lymphoma itself might induce the M. genavense lymphadenitis. This case highly alerts clinicians to the immunosuppressive state of EBV-positive LPD with latency type III even if any immunodeficient serological factors are not detected.
|Figure 1. PET-CT images on admission. PET-CT on admission shows (a) multiple enlargement of subphrenic lymph nodes and (b) SUVmax 11.1 in the right inguinal lymph node.|
|Figure 2. Pathological findings of the inguinal lymph node biopsy. (a) Ziehl-Neelsen staining of the right inguinal lymph node biopsy specimen shows acid-fast bacilli in granuloma (dashed-line circle). (b) HE staining shows atypical large lymphoma cells with T cells in the background. (c) In-situ hybridization for Epstein-Barr virus-encoded small RNA (EBER-ISH) is positive. Immunohistochemical staining shows (d) EBNA-2 partially positive, and (e) PD-L1 positive (x400 (b, e), x200 (c, d) at original magnification).|
|Table 1(A). The summary of patients with M. genavense infection and malignant lymphoma.|
|Table 1(B). The summary of patients with concomitant NTM infection and malignant lymphoma.|