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

J Korean Med Sci. 2007 Sep;22 Suppl(Suppl):S167-70. doi: 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.

Publication types

  • Case Reports

MeSH terms

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