医源性免疫失调导致初见于皮肤的EB病毒相关B细胞淋巴瘤
Epstein-Barr virus-associated B-cell lymph-oma in the setting of iatrogenic immune dysregulation presenting initially in the skin作者机构：School of Medicine and Public Health Ohio State University Columbus OH United States
出 版 物：《世界核心医学期刊文摘（皮肤病学分册）》 (Digest of the World Core Medical JOurnals:Dermatology)
年 卷 期：2005年第1卷第11期
页 面：11-12页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：B细胞淋巴瘤 EB病毒 免疫抑制剂 胸苷激酶 边缘带 甲氨蝶呤 类风湿性关节炎 环孢素 溶原 播散性
摘 要：Background: Epstein-Barr virus (EBV)has been implicated in B-cell lymphoma associated with iatrogenic immune dysregulation, primarily in the context of extracutaneous lymphoma. Methods: We describe six patients, five transplant recipients receiving cyclosporine and one patient with rheumatoid arthritis receiving methotrexate,who developed cutaneous presentations of EBV-associated B-cell lymphoma. Human herpesvirus 8 (HHV8)and EBV thymidine kinase (vTK)expression were also explored. Results: The cases comprised plasmablastic lymphoma (one case), plasmacytic marginal zone lymphoma (two cases), and diffuse large B-cell lymphoma (three cases). There was a monoclonal gammopathy in one and concurrent extracutaneous disease in two of the six patients. EBV-associated latent small nuclear RNA was detected in all cases with coexpression of HHV8 in one of the five cases and of vTK in three of the six cases. Three patients responded to a reduction in the immunosuppressive regimen and antiviral therapy. Recurrent disease developed in two, with one patient succumbing to multiorgan dissemination. Conclusions: EBV-associated cutaneous B-cell lymphoma is characterized by a long interval between the initiation of immunosuppression and the development of lymphoma. Although previous reports have reported an indolent clinical course, an aggressive clinical course may occur. HHV8 and lytic phase EBV antigens are detected in some cases, possibly suggesting a pathogenetic role.
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