Miliary tuberculosis in a patient with Epstein-Barr virus-associated angioimmunoblastic lymphadenopathy

Ann Hematol. 1996 May;72(5):333-5. doi: 10.1007/s002770050182.

Abstract

A 74-year-old woman developed angioimmunoblastic lymphadenopathy (AILD) with involvement of intra-abdominal and retroperitoneal lymph nodes. Southern blot analysis showed germline configuration of the JH genes and an oligoclonal pattern of the TcR beta genes. The immunoblasts were of B-cell phenotype and often expressed the CD30 antigen and the latent membrane protein 1 (LMP1) oncogene. Six nonsilent point mutations were identified near the 3' end of the LMP1 gene, leading to a cluster of six amino acid changes within a protein domain needed for maximal NF-kappa B stimulation. After a clinical remission of 8 months the patient relapsed with generalized lymphadenopathy and died secondary to tuberculosis. The oligoclonal rearrangements of the TcR beta genes may reflect an unsuccessful cellular immune response to Mycobacterium tuberculosis or an HLA-restricted T-cell response to B-immunoblasts expressing mutated viral antigens. A positive percutaneous tuberculin test observed 6 months prior to the onset of AILD is in favor of the first possibility.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Female
  • Herpesviridae Infections / complications*
  • Herpesvirus 4, Human* / genetics
  • Humans
  • Immunoblastic Lymphadenopathy / complications*
  • Immunoblastic Lymphadenopathy / pathology
  • Immunoblastic Lymphadenopathy / virology*
  • Point Mutation
  • Tuberculosis, Miliary / complications*
  • Tuberculosis, Miliary / pathology
  • Viral Matrix Proteins / genetics

Substances

  • EBV-associated membrane antigen, Epstein-Barr virus
  • Viral Matrix Proteins