Muso E, Fujiwara H, Yoshida H, Hosokawa R, Yashiro M, Hongo Y, Matumiya T, Yamabe H, Kikuta H, Hironaka T
Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.
Clin Nephrol. 1993 Jul;40(1):7-15.
A patient with recurrent renal failure due to massive interstitial nephritis caused by Leu 3a + 3b-positive T-cell infiltration and associated with multiple thromboembolic attacks is reported. He died of gastrointestinal bleeding after treatment with anticancer agents. At autopsy, diffuse necrosis of the bilateral kidneys was noted as well as giant coronary aneurysms filled with thrombus that resembled those seen in Kawasaki disease and multiple old myocardial infarcts were also present. Among the various Epstein-Barr virus (EBV)-specific antibodies, the titers anti-viral capsid antigen (VCA) and anti-early antigen (EBEA) IgG antibody were always very high in contrast to the relatively low titers of anti-EB nuclear antigen (EBNA) antibodies. DNA extracted from kidney tissue obtained at autopsy was analyzed by Southern blot hybridization after the amplification of EBV-specific DNA by the polymerase chain reaction. In situ hybridization of kidney tissue obtained at biopsy was also performed using an enzyme-linked probe derived from the EBV-encoded RNA 1 (EBER1) gene. As a result, the EBV genome was found both at autopsy and in the biopsy tissue, which clearly revealed EBER1 in the interstitial cells. Taking account of the progressive ST-T changes of the electrocardiograms which were normal early in his course, multiple myocardial infarction associating multiple giant aneurysms probably occurred during this disease process. Thus, it could be concluded that chronic active EBV infection contributed massive interstitial nephritis mediated by the activation of Leu 3a + 3b-positive T cells.
报告了一名因Leu 3a + 3b阳性T细胞浸润引起的大量间质性肾炎导致复发性肾衰竭并伴有多次血栓栓塞发作的患者。他在接受抗癌药物治疗后死于胃肠道出血。尸检时，发现双侧肾脏弥漫性坏死，以及充满血栓的巨大冠状动脉瘤，类似于川崎病所见，还存在多处陈旧性心肌梗死。在各种爱泼斯坦-巴尔病毒（EBV）特异性抗体中，抗病毒衣壳抗原（VCA）和抗早期抗原（EBEA）IgG抗体的滴度始终非常高，而抗EB核抗原（EBNA）抗体的滴度相对较低。通过聚合酶链反应扩增EBV特异性DNA后，对尸检时获得的肾脏组织提取的DNA进行Southern印迹杂交分析。还使用源自EBV编码RNA 1（EBER1）基因的酶联探针，对活检时获得的肾脏组织进行原位杂交。结果，在尸检和活检组织中均发现了EBV基因组，在间质细胞中清晰显示出EBER1。考虑到其病程早期心电图正常，而后期出现进行性ST-T改变，在此疾病过程中可能发生了伴有多个巨大动脉瘤的多次心肌梗死。因此，可以得出结论，慢性活动性EBV感染导致由Leu 3a + 3b阳性T细胞激活介导的大量间质性肾炎。
