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Atypical clonal T-cell proliferation in infectious mononucleosis

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Abstract

An atypical case of infectious mononucleosis characterized by fever, acute tonsillitis, and bilateral cervical adenopathy is reported in a previously healthy young man. Although serology was positive for the Epstein-Barr virus, the patient did not display peripheral blood lyrnphocytosis or atypical, reactive lymphocytes. The patient’s tonsilar tissue revealed an expanded T-zone of diffuse, monomorphous lymphocytes suggestive of lymphoma. Immunophenotypic analysis of the tonsilar tissue demonstrated more than 90% expression of pan-T markers, while pan-B markers were positive in 5-10% of the interfollicular T-zone cells and in 90% of germinal centre cells. In situ hybridization with a probe specific for EBER1 demonstrated positive staining in approximately 1% of the interfollicular tonsilar lymphocytes. Finally, Southern blot analysis of tonsilar tissue demonstrated a clonal rearrangement of the T-cell receptor gene. The patient recovered from his infection and remains in good health years after presenting with his illness. This case illustrates that T-cell clonality must be evaluated with caution in the setting of a viral infection and can occur in association with benign, self-limited infectious mononucleosis.

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Authors and Affiliations

  1. Department of Oncology, Montenore Medical Center, 111 East 210th Street, 10467, Bronx, New York

    Ummekalsoom R. Malik, Leslie Oleksowicz, Janice P. Dutcher & Peter H. Wiernik

  2. Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

    Howard Ratech

  3. Albert Einstein Cancer Center, Johns Hopkins University Medical Center, Baltimore, Maryland, USA

    Leslie Oleksowicz, Janice P. Dutcher & Peter H. Wiernik

  4. Johns Hopkins University Medical Center, Baltimore, Maryland, USA

    Michael J. Borowitz

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  1. Ummekalsoom R. Malik
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  2. Leslie Oleksowicz
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Malik, U.R., Oleksowicz, L., Dutcher, J.P. et al. Atypical clonal T-cell proliferation in infectious mononucleosis. Med Oncol 13, 207–213 (1996). https://doi.org/10.1007/BF02990933

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