Acibadem Pathology Laboratory, Istanbul, Turkey.
Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, Osaka, Japan.
Malar J. 2018 Oct 5;17(1):349. doi: 10.1186/s12936-018-2497-9.
Malaria is known to cause acute and deadly complications. However, malaria can cause unforeseen pathologies due to its chronicity. It increases the risk of endemic Burkitt Lymphoma development by inducing DNA damage in germinal centre (GC) B cells, and leading higher frequency of Epstein-Barr virus (EBV)-infected cells in GCs. EBV is well known for its tropism for B cells. However, less is known about EBV's interaction with T cells and its association with T cell lymphoma.
A 43-year-old Sudanese male admitted to hospital in Istanbul, Turkey, a non-endemic country, with hyperpigmented painful skin rashes on his whole body. A complete blood count and a peripheral blood smear during admission revealed large granular lymphocytes (LGLs) with abnormally higher CD8 T cell numbers. Additional skin biopsy and pathology results were compatible with CD8 T cell lymphoproliferative disorder with skin involvement. Patient was treated and discharged. However, a pathologist noticed unusual structures in skin tissue samples. Careful evaluation of skin biopsy samples by polarized microscopy revealed birefringent crystalloid structures resembling malarial haemozoin mainly loaded in macrophages and giant histiocytes. After purification of DNA from the skin biopsy samples, nested PCR was performed for the detection of Plasmodium parasites and Plasmodium falciparum DNA was amplified. Because, the co-presence of EBV infection with malaria is a well-known aetiology of lymphoma, EBV-early RNA (EBER) transcripts were investigated in paraffin-embedded tissue samples and found to be positive in macrophage-like histiocytes.
This is a unique case of malaria and EBV infection in a T-LGL lymphoma patient who presented in a non-endemic country. This case emphasizes the clinical importance of EBV monitoring in T-LGL patients with skin involvement. Notably, Plasmodium infection should be examined in patients from malaria endemic regions by pathological and molecular investigations.
疟疾已知可引起急性和致命的并发症。然而，由于其慢性，疟疾可能会导致意想不到的病理学。它通过诱导生发中心（GC）B 细胞中的 DNA 损伤，并导致 GC 中 EBV 感染细胞的更高频率，从而增加了地方性伯基特淋巴瘤发展的风险。EBV 以其对 B 细胞的嗜性而闻名。然而，对于 EBV 与 T 细胞的相互作用及其与 T 细胞淋巴瘤的关联，人们知之甚少。
一名 43 岁的苏丹男性因全身色素沉着疼痛性皮疹入住土耳其伊斯坦布尔的一家非地方性医院。入院时的全血细胞计数和外周血涂片显示异常高数量的 CD8 T 细胞的大颗粒淋巴细胞（LGL）。额外的皮肤活检和病理结果与伴有皮肤受累的 CD8 T 细胞淋巴增生性疾病相符。患者接受了治疗并出院。然而，一位病理学家注意到皮肤组织样本中的异常结构。通过偏光显微镜对皮肤活检样本进行仔细评估显示，双折射结晶结构类似于主要负载在巨噬细胞和巨大组织细胞中的疟原血红素。从皮肤活检样本中提取 DNA 后，进行巢式 PCR 检测以检测疟原虫，扩增了恶性疟原虫 DNA。因为疟疾和 EBV 感染的共存是淋巴瘤的已知病因，因此在石蜡包埋组织样本中研究了 EBV-早期 RNA（EBER）转录物，并在巨噬细胞样组织细胞中发现为阳性。
这是一例在非地方性国家发生的 T-LGL 淋巴瘤患者中疟疾和 EBV 感染的独特病例。该病例强调了在皮肤受累的 T-LGL 患者中监测 EBV 的临床重要性。值得注意的是，应通过病理和分子研究检查来自疟疾流行地区的患者是否存在疟原虫感染。
