Dussol B, Bernard O, Xerri L, Stoppa A M, Brunet P, Maraninchi D, Berland Y
Service de Néphrologie et Hémodialyse, Hôpital Sainte-Marguerite, Marseille.
Presse Med. 1995 Jun 17;24(22):1033-5.
Forty-six days after renal transplantation for inborn tubulointerstitial nephropathy, an 18-year-old man was rehospitalized for renal failure with creatinine at 200 mumol/l. There was no sign of infection and ciclosporin level was within therapeutic range. Transplant biopsy showed minor interstitial infiltration with mononucleated cells. Methylprednisolone by 10 mg/kg/d bolus did not improve renal function and OKT3 5 mg/d was substituted for ciclosporin but had to be stopped on day 8 because of a severe infectious syndrome. The patient developed fever (39 degrees C), erythemato-pultaceous pharyngitis followed by major multiple lymph node and spleen enlargement. The diagnosis of primary Epstein-Barr infection was confirmed serologically. Histology of a submaxillary lymph node reported monomorphic immunoblastic lymphoproliferation. Immunologic phenotyping showed CD19, CD20 and CD22 surface antigens characteristic of B cells and in situ Epstein-Barr hybridization was positive in 100% of the cells. Southern Blot showed an oligoclonal pattern. Ciclosporin and azathioprin were stopped and the patient was treated with corticosteroids (15 mg/d) and aciclovir given orally (3.2 g/d) for 3 months. Outcome at six months was favorable with normalization of the renal function and complete regression of the infectious syndrome. This case demonstrated the importance of molecular biology techniques for virologic and genotypic assessment of lymphomatous proliferation allowing positive aetiologic diagnosis.
一名18岁男性因先天性肾小管间质性肾病接受肾移植46天后，因肾衰竭再次入院，肌酐水平为200μmol/l。无感染迹象，环孢素水平在治疗范围内。移植肾活检显示有单核细胞轻度间质浸润。给予甲泼尼龙10mg/kg/d冲击治疗，肾功能未改善，遂将环孢素换成OKT3 5mg/d，但因严重感染综合征在第8天停药。患者出现发热（39℃），红斑丘疹性咽炎，随后出现多处主要淋巴结和脾脏肿大。血清学检查确诊为原发性EB病毒感染。颌下淋巴结组织学检查报告为单形性免疫母细胞性淋巴增殖。免疫表型分析显示CD19、CD20和CD22表面抗原为B细胞特征性抗原，原位EB病毒杂交100%的细胞呈阳性。Southern印迹显示寡克隆模式。停用环孢素和硫唑嘌呤，患者接受皮质类固醇（15mg/d）和口服阿昔洛韦（3.2g/d）治疗3个月。6个月时结果良好，肾功能恢复正常，感染综合征完全消退。该病例证明了分子生物学技术在淋巴瘤增殖的病毒学和基因分型评估中的重要性，有助于做出阳性病因诊断。
