Epstein-Barr Virus-associated Lymphoproliferative Disorder with Encephalitis Following Anti-thymocyte Globulin for Aplastic Anemia Resolved with Rituximab Therapy: A Case Report and Literature Review

Kiyomi Mashima; Shingo Yano; Hiroki Yokoyama; Takeshi Saito; Tomohito Machishima; Takaki Shimada; Yuichi Yahagi; Shinobu Takahara; Katsuki Sugiyama; Yoji Ogasawara; Jiro Minami; Yutaro Kamiyama; Atsushi Katsube; Kazuhito Suzuki; Sayaka Ohshima; Hisashi Yamada; Noriko Usui; Keisuke Aiba

doi:10.2169/internalmedicine.56.7722

CASE REPORTS

Epstein-Barr Virus-associated Lymphoproliferative Disorder with Encephalitis Following Anti-thymocyte Globulin for Aplastic Anemia Resolved with Rituximab Therapy: A Case Report and Literature Review

Kiyomi Mashima, Shingo Yano, Hiroki Yokoyama, Takeshi Saito, Tomohito Machishima, Takaki Shimada, Yuichi Yahagi, Shinobu Takahara, Katsuki Sugiyama, Yoji Ogasawara, Jiro Minami, Yutaro Kamiyama, Atsushi Katsube, Kazuhito Suzuki, Sayaka Ohshima, Hisashi Yamada, Noriko Usui, Keisuke Aiba

Author information

Kiyomi Mashima
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Shingo Yano
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Hiroki Yokoyama
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Takeshi Saito
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Tomohito Machishima
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Takaki Shimada
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Yuichi Yahagi
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Shinobu Takahara
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Katsuki Sugiyama
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Yoji Ogasawara
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Jiro Minami
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Yutaro Kamiyama
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Atsushi Katsube
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Kazuhito Suzuki
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Sayaka Ohshima
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
Hisashi Yamada
Research Center for Medical Science, Core Research Facilities for Basic Science (Molecular Genetics), The Jikei University School of Medicine, Japan
Noriko Usui
Department of Oncology and Hematology, The Jikei University School of Medicine, Daisan Hospital, Japan
Keisuke Aiba
Department of Oncology and Hematology, The Jikei University School of Medicine, Japan

Keywords: Anti-thymocyte globulin, Epstein-Barr virus, aplastic anemia, encephalitis, rituximab, lymphoproliferative disorder

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 6 Pages 701-706

DOI https://doi.org/10.2169/internalmedicine.56.7722

Details

Abstract

Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs) sometimes occur following Anti-thymocyte globulin (ATG) administration for allogenic stem cell transplantation but are rare in aplastic anemia (AA) patients. A 55-year-old woman with AA following ATG developed refractory fever and was diagnosed with EBV-LPD. She was successfully treated with weekly rituximab monotherapy; however, she developed EBV encephalitis. She was admitted to the intensive care unit and finally recovered from unconsciousness. EBV-LPD should be considered after ATG for AA when symptoms appear. Because EBV-LPD following ATG for AA can rapidly progress, weekly monitoring of EBV-DNA and early intervention may be necessary.

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