Vascular lesion in a patient of chronic active Epstein-Barr virus infection with hypersensitivity to mosquito bites: vasculitis induced by mosquito bite with the infiltration of nonneoplastic Epstein-Barr virus-positive cells and subsequent development of natural killer/T-cell lymphoma with angiodestruction

Hum Pathol. 2005 Feb;36(2):212-8. doi: 10.1016/j.humpath.2004.11.005.

Abstract

This report describes a vasculitis and subsequently developing angiodestructive lymphoma in an 11-year-old Japanese-Filipino girl exhibiting mosquito allergy with the background of chronic active Epstein-Barr virus (EBV) infection. She developed necrotic skin ulcer at the site of mosquito bite, and histopathological examination revealed EBV-positive mononuclear cell infiltration throughout the wall of small-sized muscular artery. These EBV-positive lymphoid cells were oligoclonal in Southern blot analysis for EBV terminal repeats. Effectiveness of steroid therapy also supports the nonneoplastic nature. Approximately 1 year later, she developed progressive large skin ulcer without mosquito bites. Microscopically, the angiocentric or angiodestructive pattern of EBV-positive atypical cells supported the diagnosis of extranodal natural killer/T-cell lymphoma. Southern blot analysis revealed the monoclonal neoplastic nature of EBV-positive cells. In contrast to the primary mosquito bite lesion, natural killer/T-cell lymphoma cells exhibited the higher expression of EBV latent membrane protein 1 mRNA and the apparent protein expression detected by immunohistochemistry.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Child
  • Culicidae*
  • Epstein-Barr Virus Infections / immunology
  • Epstein-Barr Virus Infections / pathology*
  • Female
  • Herpesvirus 4, Human / genetics
  • Herpesvirus 4, Human / isolation & purification
  • Humans
  • Immunohistochemistry
  • Insect Bites and Stings / immunology
  • Insect Bites and Stings / pathology*
  • Insect Bites and Stings / virology
  • Killer Cells, Natural / immunology
  • Lymphoma, T-Cell, Cutaneous / immunology
  • Lymphoma, T-Cell, Cutaneous / pathology*
  • Necrosis
  • RNA, Messenger / metabolism
  • RNA, Viral / genetics
  • Skin / blood supply
  • Skin / pathology*
  • Vasculitis, Leukocytoclastic, Cutaneous / immunology
  • Vasculitis, Leukocytoclastic, Cutaneous / pathology*
  • Viral Matrix Proteins / genetics
  • Viral Matrix Proteins / metabolism

Substances

  • EBV-associated membrane antigen, Epstein-Barr virus
  • RNA, Messenger
  • RNA, Viral
  • Viral Matrix Proteins