Cattoir L, Van Hende V, De Paepe P, Padalko E
Acta Clin Belg. 2014 Aug;69(4):262-6. doi: 10.1179/2295333714Y.0000000037. Epub 2014 Jun 10.
We present the case of a 27-year-old immunocompetent man who progressively developed a generalized lymphadenopathy and B symptoms. Results of Epstein-Barr virus (EBV) serology were suggestive for a past infection, but the EBV viral load in whole blood was high. Also, core needle biopsy of the largest lymph node showed an image which could fit an EBV-driven reactive lymphoproliferation. Despite the absence of an immune disorder, all medical evidence points to an EBV-driven lymphoproliferative proces. In immunocompetent patients, it seems extremely uncommon to detect a high EBV viral load in the absence of serological evidence of an acute EBV infection or reactivation. We reviewed literature on this topic and on the selection of the appropriate sample type for EBV PCR, as this is known to be a critical point. Serological testing for the diagnosis of EBV infection is the gold standard in immunocompetent patients. Measuring EBV viral load is only recommended when dealing with immunocompromised patients. Although extremely rare, this case report shows that there is a place for EBV PCR in certain situations in immunocompetent patients. Besides, there is still no consensus regarding the specimen of choice for the determination of the EBV viral load. The preferred specimen type seems to depend on the patient's underlying condition.
我们报告了一例27岁免疫功能正常的男性病例，该患者逐渐出现全身淋巴结肿大和B症状。爱泼斯坦-巴尔病毒（EBV）血清学检测结果提示既往感染，但全血中的EBV病毒载量很高。此外，对最大淋巴结进行的粗针活检显示的图像符合EBV驱动的反应性淋巴细胞增生。尽管没有免疫紊乱，但所有医学证据均指向EBV驱动的淋巴细胞增生过程。在免疫功能正常的患者中，在没有急性EBV感染或再激活的血清学证据的情况下检测到高EBV病毒载量似乎极为罕见。我们回顾了关于该主题以及EBV PCR合适样本类型选择的文献，因为这是一个关键点。在免疫功能正常的患者中，EBV感染诊断的血清学检测是金标准。仅在处理免疫功能低下的患者时才建议检测EBV病毒载量。尽管极为罕见，但本病例报告表明，在某些情况下，EBV PCR在免疫功能正常的患者中也有应用价值。此外，关于确定EBV病毒载量的首选样本仍未达成共识。首选的样本类型似乎取决于患者的基础疾病状况。
