Yonezawa Akihito, Onaka Takashi, Imada Kazunori
Department of Hematology, Kokura Memorial Hospital.
Rinsho Ketsueki. 2009 Aug;50(8):652-7.
Most cases of infectious mononucleosis (IM) are caused by Epstein-Barr virus (EBV). Other pathogens have been reported to cause heterophile-negative mononucleosis-like syndrome, including cytomegalovirus (CMV) and human immunodeficiency virus type-1 (HIV-1). Primary CMV infection is often asymptomatic in immunocompetent individuals. In this article, we describe a patient with prolonged fever and fatigue, who developed transient monoclonal CD8+ T-cell lymphocytosis after primary CMV infection. Monoclonal gene rearrangement of T-cell receptor (TCR) beta locus was transiently detected in DNA from peripheral lymphocytes. Monoclonal rearrangement and atypical lymphocytosis disappeared after treatment with anti-viral agents. These observations imply that monoclonal expansion of T-cells could be a reactive phenomenon of primary CMV infection and TCR gene rearrangement is not specific for malignancy. Physicians should carefully follow patients with monoclonal expansion of CD8+ T-cells after CMV-IM in order to rule out T cell malignancy.
大多数传染性单核细胞增多症（IM）病例由 Epstein-Barr 病毒（EBV）引起。据报道，其他病原体可导致嗜异性抗体阴性的单核细胞增多症样综合征，包括巨细胞病毒（CMV）和 1 型人类免疫缺陷病毒（HIV-1）。原发性 CMV 感染在免疫功能正常的个体中通常无症状。在本文中，我们描述了一名长期发热和疲劳的患者，该患者在原发性 CMV 感染后出现了短暂的单克隆 CD8 + T 细胞淋巴细胞增多。在外周淋巴细胞的 DNA 中短暂检测到 T 细胞受体（TCR）β 基因座的单克隆基因重排。抗病毒药物治疗后，单克隆重排和非典型淋巴细胞增多消失。这些观察结果表明，T 细胞的单克隆扩增可能是原发性 CMV 感染的一种反应性现象，并且 TCR 基因重排并非恶性肿瘤所特有。CMV-IM 后 CD8 + T 细胞单克隆扩增的患者，医生应仔细随访，以排除 T 细胞恶性肿瘤。
