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Epstein-Barr virus lymphoproliferative disorder in children with leukemia: case report and review of the literature.

PURPOSE
The purpose of this study is to report a case of Epstein-Barr virus-related lymphoproliferative disorder (EBV-related LPD) in a child with leukemia and present a review of literature on the subject.


PATIENTS AND METHODS
A 6-year-old boy with acute lymphoblastic leukemia (ALL) undergoing maintenance chemotherapy presented with fever, abdominal pain, and vomiting. Imaging studies revealed multiple mass lesions in the liver, kidneys, and lungs. Liver biopsy was obtained. Immunocytochemistry for T and B lymphocytes and in situ hybridization for evidence of latent EBV infection was performed.


RESULTS
Hepatic portal tracts were infiltrated with lymphocytes, monocytes, eosinophils, and large atypical mononuclear cells. Both T and B lymphocytes were present, but the large atypical cells were of B origin and were positive for latent EBV infection. Chemotherapy was discontinued, and the patient was treated with intravenous gammaglobulin, interferon, and acyclovir. He had an excellent response and has been free of disease for 19 months.


CONCLUSION
EBV-related LPD can complicate the course of patients with ALL in remission. The clinical findings and diagnosis in patients with ALL are similar to other immunocompromised patients. Withdrawal of chemotherapy and treatment with immune modulators should be strongly considered.