Atypical clonal T-cell proliferation in infectious mononucleosis

Med Oncol. 1996 Dec;13(4):207-13. doi: 10.1007/BF02990933.

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 lymphocytosis 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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Blotting, Southern
  • Diagnosis, Differential
  • Gene Rearrangement, T-Lymphocyte / genetics
  • Herpesvirus 4, Human / isolation & purification
  • Humans
  • Infectious Mononucleosis / diagnosis
  • Infectious Mononucleosis / genetics
  • Infectious Mononucleosis / immunology*
  • Infectious Mononucleosis / pathology
  • Lymphoproliferative Disorders / genetics
  • Lymphoproliferative Disorders / pathology
  • Lymphoproliferative Disorders / virology
  • Male
  • Nucleic Acid Hybridization
  • Palatine Tonsil / pathology
  • T-Lymphocytes / immunology*