Ebstein-Barr Virus Research Articles

Expression of Serum Sialic Acid, Early Antigen-IgA, and Viral Capsid Antigen-IgA in Nasopharynx Cancer Patients: The Diagnostic Implication of Combined Assays.

BackgroundEbstein-Barr virus (EBV) plays a critical role in nasopharynx cancer, which can be effectively monitored by serum levels of early antigen antibody (EA-IgA) and viral capsid antigen antibody (VCA-IgA). This study explored the diagnostic value of combined assays of sialic acid (SA), EA-IgA, and VCA-IgA via the expressional assay.Material/MethodsA total of 42 nasopharynx cancer patients and 42 benign rhinitis and healthy controls were recruited in this study. Serum EA-IgA and VCA-IgA were tested by enzyme-linked immunosorbent assay (ELISA) and enzymatic assay of serum SA. Specificity and sensitivity of those 3 assays were compared. The diagnostic value of each parameter was evaluated by ROC curves.ResultsAll 3 indexes (SA, EA-IgA and VCA-IgA) showed elevated serum levels in nasopharynx cancer patients when compared to those with rhinitis, who had higher levels than healthy individuals. Concentrations of these factors were also positively correlated with the TNM staging of cancer. The sensitivity and specificity were 30.95% and 83.33% (in SA), 57.14% and 95.24% (in EA-IgA), and 76.19% and 92.86% (in VCA-IgA), respectively. VCA-IgA had the highest sensitivity among all 3 indexes. The combined assay increased the diagnostic sensitivity to 92.86% without compromising specificity.ConclusionsSA, EA-IgA, and VCA-IgA levels were significantly elevated in nasopharynx patients’ serum. The combined assay may have clinical value in diagnosis and monitoring.

Allogeneic Stem Cell Transplantation Using In Vivo T-Cell Depletion in Myeloid Disorders

Introduction:Alemtuzumab is used for in vivo T-cell depletion to reduce graft versus host disease in allogeneic Stem Cell Transplantation (SCT). Profound lymhotoxicity of this monocloncal antibody can potentially increase morbidity and mortality in SCT due to excessive viral infections and increased risk of graft rejection. We retrospectively analysed outcome of patients with myeloid disorders (acute myeloid leukaemia and myelodysplasia) who received in vivo T-cell depletion using Alemtuzumab based conditioning for allogeneic SCT over a period of 3 years in our centre.Methods:Patients were identified from department transplant data base. Data was collected for 73 consecutive patients over a period of three years using patient medical records, clinical work station and electronic patient records. The conditioning regimen included Fludarabine 30mg/m2 x5 (days -7 to -3), Alemtuzumab 10mgx5 (days -8 to -4) and Melphalan 140mg/m2 (day -2). Chimerism analysis was performed by polymerase chain reaction (PCR) to identify short tandem repeats within peripheral blood leucocytes and CD3 fraction. The quantification of donor chimerism was done by using gel photography system and LabWroks software. Viral testing was performed by PCR analysis.Results:Median age for the patients was 59 years (range 41-71). Median duration of follow up was 19 months (4-49 months). The majority of patients (67%) received SCT from a voluntary unrelated donor. Sixty four patients (88%) had AML whilst 9 had myelodysplasia. Sixty five (89%) patients were in morphological complete remission (<5% blasts) at the time of SCT. Median HCT-Comorbidity index was 2 (range 1-5). Median time to neutrophil engraftment was 13 days (range 9-23) and platelet engraftment 14 days (median 8-48). During the course of transplantation, 50 patients were treated for neutropenic fever with broad spectrum antibiotics and 16 for presumed fungal infection. Forty three patients (59%) reactivated cytomegalovirus (CMV), 10 (13%) had Ebstein Barr Virus (EBV) viremia and 4 (5%) were found to have adenovirus on peripheral blood PCR analysis after SCT. Denovo acute graft versus host disease (grade 2-4) required treatment in 12 patients (16%) whilst chronic GVHD was seen in 14% (n=10). 20 patients required donor lymphocyte infusion due to mixed chimerism after SCT. Total incidence of acute GVHD (grade 2-4) was 23% (n=17) and that of chronic GVHD was 15%. Median donor chimerism in peripheral blood leucocyte fraction was 100% at day 30, 60, 90 and 180 after SCT. Chimerism analysis on CD3 compartment showed 100%, 96%, 95.5% and 95% donor fraction respectively at these time points. Predicted overall survival at 2 years was 53% and Event Free Survival 49%. Non relapsed mortality in this cohort was 18% at one year. One patient had primary graft rejection with no secondary graft rejections. Overall survival was not statistically different between those who were treated for viremia (CMV, EBV, adenovirus) when compared to those who did not have viremia (p=0.31). No deaths were attributed to either CMV or EBV.Conclusion:Our retrospective data show that Alemtuzumab based conditioning regimen in myeloid disorders have low incidence of GVHD, very low risk of graft rejection and comparable overall survival to those conditioning regimens which utilize in vivo T-cell depletion strategies other than Alemtuzumab. Moreover, a high incidence of viremia, in our cohort, did not translate into worse overall survival. DisclosuresSaif:Novartis: Honoraria; Alexion: Honoraria. Dignan:Jazz pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau; Therakos: Honoraria, Speakers Bureau. Tholouli:Jazz Pharmaceuticals: Honoraria, Speakers Bureau; MSD: Honoraria, Speakers Bureau; Pfizer: Honoraria, Speakers Bureau.

A Rare Case of Haemophagocytic Syndrome in a HIV Seropositive Patient with Cytomegalovirus Induced Paraparesis

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH ) is a rare but potentially life threatening condi- tion characterized by uncontrolled activation of CD8+ T lymphocytes and macrophages that leads to organ damage. HLH can be primary (familial or genetic) and secondary. Secondary HLH occurs due to infections caused mostly by viruses like Ebstein Barr virus, Cytomegalovirus (CMV), Parvo B19 etc. Early diagnosis and treatment is the key to management of HLH. We present here a case of a 30 year old female who presented with fever, jaundice, cough and progressive weakness of both lower limbs. There was no girdle like sensation, no bladder/bowel involvement. She was recently diagnosed to be seroposi- tive for Human Immuno-deficiency Virus (HIV)-1 and had a CD4 count of 27/μL. She had hepatomegaly, pancytopenia, hyperbilirubinemia, hypoalbuminemia, raised liver enzymes and hypertriglyceridemia. CSF had raised protein, reduced sugar and neutrophils. DNA PCR for CMV was positive and there was evidence of CMV disease on fundoscopy. Her bone marrow revealed presence of haemophagocytes. She was treated successfully with Ganciclovir, Dexamethasone and anti- retroviral drugs and was discharged.

Pemodelan Matematika Bekam Pada Kanker Nasofaring Dan Kontribusinya Bagi Penanganan Kanker Nasofaring

Cancer / Nasopharyngeal carcinoma is a cancer of the first malignancy in the head and neck. It is located in nasopharynx, behind the nose. Ebstein Barr virus is one of the triggers of this carcinoma. Cupping is a process of detoxification of toxins in the body so as immunity increases. Quite a lot of the sayings of the Prophet Muhammad about the cupping. The method used in this study mathematical modeling nasofang carcinoma cell level. There are two cases which are modeled in this case, the first case of low immunity without cupping, and second case low immunity with the cupping. The first case of low immunity without a cupping here are seven sub-populations that happened, ie normal cells, lesion cells, low dysplastic cells, the infected cells, high dysplastic cells, invasive carcinoma cells and viruses. Meanwhile, two cases of low immunity with the cupping there are five sub-populations, ie normal cells, lesion cells, low dysplastic cells, the infected cells, and viruses.

XII. Therapeutic exploitation of autologous T-cell activation in B-cell lymphoma.

XII. Therapeutic exploitation of autologous T-cell activation in B-cell lymphoma.

HIV associated Lymphocytic Interstitial Pneumonia: a clinical, histological and radiographic study from an HIV endemic resource-poor setting.

BackgroundThere is a paucity of clinical and histopathological data about HIV-associated lymphocytic interstitial pneumonitis (LIP) in adults from HIV endemic settings. The role of Ebstein-Barr virus (EBV) in the pathogenesis remains unclear.MethodsWe reviewed the clinical, radiographic and histopathological features of suspected adult LIP cases at the Groote Schuur Hospital, Cape Town South Africa, over a 6 year period. Archived tissue sections were stained for CD3, CD4, CD8, CD20 and LMP-1 antigen (an EBV marker).Results42 cases of suspected LIP(100% HIV-infected) were identified. 75% of patients were empirically treated for TB prior to being referred to the chest service for further investigation. Tissue samples were obtained using trans-bronchial biopsy. 13/42 were classified as definite LIP (lymphocytic infiltrate with no alternative diagnosis), 19/42 probable LIP (lymphocytic infiltrate but evidence of anthracosis or fibrosis) and 10 as non-LIP (alternative histological diagnosis). Those with definite LIP were predominantly young females (85%) with a median CD4 count of 194 (IQR 119–359). Clinical or radiological features had poor predictive value for LIP. Histologically, the lymphocytic infiltrate comprised mainly B cells and CD8 T cells. The frequency of positive EBV LMP-1 antigen staining was similar in definite and non- LIP patients [(2/13 (15%) vs. 3/10 (30%); p = 0.52].ConclusionsIn a HIV endemic setting adult HIV-associated LIP occurs predominantly in young women. The diagnosis can often be made on transbronchial biopsy and is characterized by a predominant CD8 T cell infiltrate. No association with EBV antigen was found.

G461(P) Characteristics of haemophagocytic lymphohistiocytosis at a teritiary paediatric centre

Aim Haemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disorder. It can present to many specialities and individual Paediatricians are unlikely to develop significant experience of it. Early recognition and treatment improves the clinical outcome. The genetic basis of HLH is evolving and identification of viral triggers influencing management. We aimed to study cases of HLH presenting to our tertiary Paediatric Hospital to identify the proportion of de novo cases and evaluate the role of Ebstein Barr virus (EBV) and genetic defects in the pathogenesis of HLH. Methods Immunology, Rheumatology and Haematology Consultants identified children diagnosed with HLH over a 10 year period from 2003–2013. ICD10 codes were cross referenced. Case notes and electronic data were interrogated to extract relevant data. Results 20 children were diagnosed with HLH over the 10 year period. Seven patients were de novo diagnoses and 13 had known haematological malignancy or rheumatological conditions. At presentation, 15% met the HLH 2004 diagnostic criteria, rising to 45% at time of diagnosis (Figure 1). Viral triggers were investigated by EBV PCR and/or throat swab in 50% of patients and all de novo HLH patients were EBV positive. Of those found to be EBV positive, Rituximab was given to 4 patients. Genetic mutations were looked for in 40% of all patients (Figure 2). Nine patients recovered with standard management, 6 died and 5 proceeded to bone marrow transplant. Conclusions HLH can present to a variety of paediatric specialities and a high index of suspicion is needed to make a timely diagnosis, as not all patients have ‘classical’ features at presentation. Identification of EBV gives the opportunity to use Rituximab effectively. In children with unusual responses to ubiquitous viruses, such as EBV, the competency of the host should be questioned. Some genetic defects predisposing to HLH in whom long term management with stem cell transplant can be curative are already known, and further defects may be discovered in the future. Accurate genetic diagnosis not only influences management, but is important for the families affected.

(855) - Tacrolimus Monotherapy After Pediatric Heart Transplantation

Routine long-term immunosuppression (IS) after pediatric heart transplantation is based on the combination of tacrolimus (TAC) and mycophenolate mofetil (MMF) or everolimus (EVE). Gastrointestinal side-effects of the MMF and/or recurrent infections related to EVE can indicate the use of TAC monotherapy. The safety of TAC monotherapy was analized. Between 2007-2014 September, 26 pediatric heart transplantations were performed in our institute (age: 3 months-16 years; male/female: 12/14; weight: 4.4-61.5 kg). Tacrolimus monotherapy was indicated in 4 cases due to recurrent side effects (age: 11-23 months; male/female: 3/1; weight: 7.6-11.4 kg). Target level of tacrolimus was determined 2 ng/ml higher than used by combined therapy. Surveillance biopsies and echocardiography were performed to detect rejections. Rejections and incidence of infections were studied retrospectively. In every case the first line therapy was the combination of TAC+MMF. In 3 of them MMF/EVE conversion was indicated due to severe enteral side-effects in spite of MMF dose reduction. TAC target level was reduced on TAC+EVE combination depending on posttransplant time. After the conversion the gastrointesinal symptoms were eliminated, but in all of 3 patients recurrent infections were occured (in 2 patients upper-airway infections, in 1 patient permanent high replication of Ebstein Barr virus developed). In 1 patient on TAC+MMF therapy CMV disease and recurrent CMV activations were detected, indicating the reduction of IS. The main follow-up were 14 months. No side-effects was documented related to higher tacrolimus-level. No rejections were detected on biopsies. Infection rate was significantly reduced in every patients. Reduced immunosuppression could be necessary in small children (<2 yrs of age) due to recurrent side effects of TAC+MMF/EVE therapy. Tacrolimus monotherapy can be a good and safe alternative with higher target level. Long-term follow-up is needed to evaluate chronic rejection.

Investigation of Epstein-Barr Virus and Human Papilloma Virus In Turkish Patients With Nasopharyngeal Carcinoma Using In-Situ Hybridisation

Nasopharyngeal carcinoma(NPC) is associated with Ebstein-Barr virus. Human papilloma virus(HPV) was also detected in a proportion of NPC cases. In this retrospective study we analyze the frequency of EBV and HPV infection family16 in 82 patients with NPC.

Correlation Analysis of Nasopharyngeal Carcinoma TNM Staging with Serum EA IgA and VCA IgA in EBV and VEGF-C and -D.

BackgroundNasopharyngeal carcinoma often occurs in humans in the nasopharyngeal epithelium area. Ebstein-Barr (EB) virus plays a key role in the process of nasopharyngeal carcinoma lesions. Early antigen antibody (EA-IgA) and viral capsid antigen IgA (VCA-IgA) of EB virus detection in serum can effectively monitor the process of nasopharyngeal carcinoma lesions. Serum vascular endothelial growth factor (VEGF) -C and VEGF-D expression detection can reflect the distant metastases ability of human tumor cells.Material/Methods153 cases of nasopharyngeal carcinoma patients in our hospital were enrolled, while 148 cases of healthy adults were selected as control. ELISA was used to detect serum EA-IgA, VCA-IgA, VEGF-C and -D expression levels. Spearman rank correlation analysis was applied to test the correlation of nasopharyngeal carcinoma TNM clinical stage and different indexes.ResultsSerum EA-IgA, VCA-IgA, VEGF-C and -D expression in nasopharyngeal carcinoma patients was 43.74±2.6 U·mL−1, 62.5±2.7 U·mL−1, 473.25±3.4 pg·mL−1, and 498.36±2.3 pg·mL−1, respectively, which was significantly higher than in the control group as 18.65±3.7 U·mL−1, 23.74±1.5 U·mL−1, 225.42±2.3 pg·mL−1, and 257.24±3.5 pg·mL−1 (P<0.05). Nasopharyngeal carcinoma TNM clinical staging was obviously correlated with serum EA-IgA, VCA-IgA, and VEGF-C (P<0.05), but not VEGF-D (P>0.05).ConclusionsNasopharyngeal carcinoma patient serum EA-IgA and VCA-IgA expression levels were significantly correlated with TNM staging. The high levels of these 3 indicators suggest advanced nasopharyngeal carcinoma TNM staging and serious lesions.

HIV-associated Burkitt lymphoma with bone marrow and cerebral invasion in a patient with history of Plasmodium falciparum infection

HIV infected patients are more likely to develop non-Hodgkin lymphoma (NHL). Burkitt lymphoma (BL) is a highly aggressive NHL, associated with immunosuppression, especially with HIV. According to WHO classification there are three clinical types of BL: endemic, sporadic and immunosuppression-associated. Sporadic lymphoma was described especially in children (40% of child lymphomas in USA and EU). Two cofactors seem to be associated with BL: Ebstein Barr virus (EBV) and Plasmodium falciparum (PF) infection. PF and EBV are well-known co-factors in the pathogenesis of BL, but the mechanisms of interaction remain unclear. We present a 51 year-old male, who developed lymphadenopathy, prolonged fever, weight loss, splenomegaly and seizure. The patient was admitted to a Hematology University Hospital. After lymph node biopsy he was diagnosed with BL. A specimen of bone marrow from the right iliac crest showed gross invasion by Burkitt tumor cells. The patient tested positive for HIV and he was referred to the National Institute of Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest. According to CDC Classification System for HIV Infection the patient had AIDS (C3 stage with a CD4 count of 39/cmm) and a high HIV viral load (500,262 copies/mL). The patient’s medical history revealed Plasmodium falciparum malaria 4 years ago, while he was living in South America. Epidemiological data revealed more than 200 sexual partners in the last two years. At admission to our hospital he had pancytopenia: white blood cells 1400/cmm, with 600 neutrophils and 600 lymphocytes, hemoglobin 9.6 g/dL and platelet count 25,000/cmm. The patient was tested for EBV infection and high titer of anti-VCA antibodies was found. ART was initiated with TDF-FTC-lopinavir/r with good virological outcome (after 6 weeks of therapy the viral load was 383 copies/mL). Cerebral MRI showed diffuse lymphomatous invasion. After 3 weeks of ART the patient was referred to Hematology Hospital where chemotherapy was started. Post-chemotherapy the pancytopenia was more severe: white blood cells – 200/cmm with CD4 count – 10/cmm, platelets – 15,000/cmm and hemoglobin – 7.9 g/dL. The BL response after chemotherapy was poor and the patient died two months after the diagnosis, despite the good virological outcome. We present a rare case of NHL in a HIV-infected patient, with multiple co-factors for BL: HIV infection, EBV infection and Plasmodium falciparum infection. The prognostic in AIDS depends on the comorbidities’ outcome.

IRIS manifesting as chronic inflammatory demyelinating polyneuropathy in HIV

Case report 45 year old female was diagnosed to have HIV with a CD4 count of 86. At the time of diagnosis, she was very much emaciated with a BMI of 16, had oral candidiasis and sensory neuropathy with numbness upto both ankles. After ruling out other opportunistic infections, she was started on tenofovir, lamivudine and nevirapine. Three months later, she presented to us with difficulty in walking and dribbling of saliva. History was suggestive of gradual worsening of peripheral neuropathy and progressive ascending limb weakness after initiation of anti retroviral therapy. Bowel and bladder involvement were not present. Clinical examination revealed areflexic quadriparesis with bilateral LMN facial palsy. Evidence of both small and large fiber neuropathy was present in both upper and lower limbs. Digital clawing was noted in both upper limbs in both ulnar and median nerve distribution. CSF study was suggestive of lymphocytic pleocytosis with mild protein elevation. MRI brain and spine were normal. Electromyographic nerve Sconduction studies were consistent with a primary demyelinating polyneuropathy involving all nerves in upper and lower limbs. CSF PCR for Cytomegalovirus, Ebstein barr virus, herpes and mycobacterium tuberculosis were negative. Since duration of symptoms was more than 2 months, a diagnosis of CIDP was made. She was given inj methylprednisolone 1 gm for 5 days followed by tapering doses of prednisolone. There was dramatic improvement in muscle power after initiation of steroids and after 2 weeks she was able to walk without support, facial palsy and digital clawing had recovered.

Epigenetics of Multiple Sclerosis: An Updated Review

Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease characterized with autoimmune response against myelin proteins and progressive axonal loss. The heterogeneity of the clinical course and low concordance rates in monozygotic twins have indicated the involvement of complex heritable and environmental factors in MS pathogenesis. MS is more often transmitted to the next generation by mothers than fathers suggesting an epigenetic influence. One of the possible reasons of this parent-of-origin effect might be the human leukocyte antigen-DRB1*15 allele, which is the major risk factor for MS and regulated by epigenetic mechanisms such as DNA methylation and histone deacetylation. Moreover, major environmental risk factors for MS, vitamin D deficiency, smoking and Ebstein-Barr virus are all known to exert epigenetic changes. In the last few decades, compelling evidence implicating the role of epigenetics in MS has accumulated. Increased or decreased acetylation, methylation and citrullination of genes regulating the expression of inflammation and myelination factors appear to be particularly involved in the epigenetics of MS. Although much less is known about epigenetic factors causing neurodegeneration, epigenetic mechanisms regulating axonal loss, apoptosis and mitochondrial dysfunction in MS are in the process of identification. Additionally, expression levels of several microRNAs (miRNAs) (e.g., miR-155 and miR-326) are increased in MS brains and potential mechanisms by which these factors might influence MS pathogenesis have been described. Certain miRNAs may also be potentially used as diagnostic biomarkers in MS. Several reagents, especially histone deacetylase inhibitors have been shown to ameliorate the symptoms of experimental allergic encephalomyelitis. Ongoing efforts in this field are expected to result in characterization of epigenetic factors that can be used in prediction of treatment responsive MS patients, diagnostic screening panels and treatment methods with specific mechanism of action.

Ebstein-Barr Virus-Associated Iris Leiomyosarcoma in an AIDS Patient : A Case Report

Importance: Report of an AIDS patient with Ebstein-Barr virus (EBV)-associated iris leiomyosarcoma.Observations: A 19-year-old AIDS patient presented with a painless rapidly growing mass in the right iris. EBVassociated leiomyosarcoma was confirmed by an immunohistochemical study of the excisional biopsy.Conclusion: This is the second case report on immunohistochemically proven EBV-associated iris leiomyosarcoma in AIDS.

Nasopharyngeal Mucoepidermoid Carcinoma - A Common Entity at an Uncommon Location

Mucoepidermoid carcinomas mostly occur in the major salivary glands, the minor salivary glands of oral cavity and in the lacrimal glands. These tumours rarely occur in the sino-nasal tract. When they occur in the sino-nasal tract, the most frequent site is the maxillary antrum, followed by the nasal cavity, the nasopharynx and the ethmoidal sinuses. As per review of literature, nasopharyngeal mucoepidermoid carcinomas account for 0.6% of salivary gland tumours and 4.8% of mucoepidermoid carcinomas. Extensive literature search revealed 21 cases of nasopharyngeal mucoepidermoid carcinomas reported till date. These cases showed an age incidence ranging from 20 to 60 years with a female preponderance. In contrast to nasopharyngeal carcinomas, these tumours show low positivity rates for Ebstein-Barr virus serological test. Histochemical positivity for mucin may be demonstrated in the glandular and mucinous components of these tumours. High grade mucoepidermoid carcinoma of nasopharynx is treated with surgical excision combined with radiotherapy and is associated with poor survival. Therefore, early diagnosis and prompt treatment are of utmost importance. This case report highlights the rare occurrence of a high grade nasopharyngeal muco-epidermoid carcinoma in a 70-year-old male and is presented for its unusual occurrence in the nasopharynx which is the most infrequent location for this lesion.

Recurrent Ebstein-Barr Virus–Associated Diffuse Large B-Cell Lymphoma in an Ascending Aorta Graft

A 51-year-old man with Marfan syndrome and multiple previous surgical interventions presented with an enlarging aortic root pseudoaneurysm. His past history was significant for type A aortic dissection at age 25 years, treated with composite root replacement with a Bjork-Shiley valved conduit. Revision of the left coronary button was performed 1 year later as a result of pseudoaneurysm formation. At age 48 years, he had documented ventricular tachycardia with an echocardiogram showing inferolateral hypokinesis. His cardiac enzymes were negative, and he received an implantable cardioverter defibrillator (ICD). Although asymptomatic, he was referred to the Marfan Clinic at our institution a few months later. Transthoracic echocardiography showed mobile density in the ascending aortic graft (Figure 1), and computed tomography (CT) angiography showed a large amount of intraluminal thrombus in the ascending aorta graft, as well as coronary button aneurysms (Figure 2). Magnetic resonance imaging of the head showed infarcts in multiple vascular distributions. The patient underwent redo aortic root replacement with a 25-mm CarboMedics composite graft that required a short segment of a saphenous vein interposition graft to the small left coronary button. A large amount of intraluminal thrombus within the ascending aorta was noted at the time of surgery (Figure 3), and histological evaluation of this thrombus revealed Ebstein-Barr virus (EBV)-associated diffuse large B-cell lymphoma (DLBCL). The neoplastic lymphocytes expressed CD20, MUM1, and BCL2 and in situ hybridization studies …

Endobronchial leiomyoma in an immunocompetent four-year-old female child

Pulmonary leiomyoma are uncommonly encountered benign mesenchymal neoplasms in children, usually found in immunosuppressed individuals in association with human immunodeficiency virus or Ebstein-Barr virus infection. We describe an interesting case of a 4-year-old immunocompetent girl who presented with pleural effusion and lung collapse secondary to endobronchial leiomyoma. She underwent a left thoracotomy and a left pneumonectomy for excision of the bronchial mass.

Pediatric Renal Transplantation: A Single Center Experience

Renal transplantation is the treatment of choice for children with end-stage renal disease. The aim of this study was to evaluate retrospectively of our 37 pediatric renal allograft recipients, including 20 boys and 17 girls from July 2007 to August 2012. The overall mean age at transplantation was 12.16 ± 4.25 years. Three patients (8.1%) were transplanted preemptively; two were ABO-incompatible transplantations. The majority of recipients received living donor grafts (81%). The mean duration of follow-up was 25.10 ± 14.95 months. Seven acute rejection episodes were observed in 6 patients (16.2%). Eleven recipients developed serious viral infections: cytomegalovirus (n = 8), parvovirus (n = 2), BK virus (polyoma hominis 1) (n = 2), or Ebstein-Barr virus (n = 1). Three patients died; one from posttransplant lymphoproliferative disease, one from primary disease recurrence with infection, and one from sepsis. In conclusion, kidney transplantation is the treatment of choice for end-stage renal disease. Infection was the major concern after this procedure.

Higher Donor Body Mass Index Is Associated with Higher Risk of Cardiac Allograft Vasculopathy

Purpose Donor and recipient characteristics that are associated with high risk of cardiac allograft vasculopathy (CAV) have not been fully elucidated. We sought to examine risk factor associations with CAV among cardiac transplant patients in our center. Methods and Materials The cardiac transplant database of a single academic center from 2003-11 was retrospectively reviewed. The outcome of CAV was defined as ≥60% stenosis in ≥1 major coronary vessel or >30% in >1 vessel. The following variables were analyzed for their association with the outcome: donor and recipient age, gender, body mass index (kg/m2), smoking, diabetes, hypertension, dyslipidemia, chronic kidney disease, cytomegalovirus/ ebstein barr virus serology and frequency of acute cellular rejection episodes within 12 months from transplantation. Cox proportional hazards regression was used to determine the association between variables and outcome. Results Of 85 transplant recipients analyzed, mean age 47; male 75%. CAV was diagnosed in 23 (27%) patients over a mean follow-up of 3.5 years. After multivariate analysis adjusting for mentioned parameters, only donor BMI was significantly associated with a higher risk of CAV (OR 1.1, 95%CI 1.0-1.2, P=0.03). For every 1 point increase in BMI, there was a 11% increase in CAV risk. The optimal cut-off for BMI to predict CAV was determined as 24. Figure 1 displays the Kaplan-Meier curves for time to CAV stratified based on BMI ≥24 (solid line) and Conclusions Higher donor BMI was independently associated with an increased risk of CAV after cardiac transplantation. Careful screening of this donor characteristic may be necessary for favorable recipient outcomes.

Herpes simplex and Ebstein Barr virus encephalitis complicated with Klüver-Bucy syndrome

Abstract A case of sixteen-year-old boy with initial herpes simplex virus (HSV) and Epstein-Barr virus (EBV) encephalitis is reported. Herpesviruses are often found in cerebrospinal fluid (CSF) along with EBV. After eradication of HSV in CSF in this case, a positive polymerase chain reaction (PCR) to EBV in CSF remained along with a severe clinical picture (segmental myoclonus and Klüver-Bucy syndrome) and worsening of brain magnetic resonance imaging (MRI) findings. Neurological and psychological improvement occurred after treatment with intravenous immunoglobulin.