PMC5410484_01
Photomicrograph of the patient's bone marrow smear at the time of diagnosis of aplastic anemia. Ninety percent of the normal bone marrow tissue was replaced by adipose tissue with no blasts or mature cells. There were no atypical or malignant cells present. Magnificationx100. Hematoxylin and Eosin staining.
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Bone marrow aspiration and biopsy showed severely hypoplastic marrow with 90% of the normal tissue replaced by adipose tissue and no evidence of increased blast cells, dysplasia, or atypical cells (Fig. 1).
Clinical course of the patient. Forty-five days after ATG initiation, the serum LDH level was elevated to more than 3,000 U/L, and the serum EBV-DNA level increased to 1.1x106 copies/106 cells. Following rituximab therapy, these levels rapidly decreased. Rituximab was administered once a week for 8 weeks.
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Her clinical course is shown in Fig. 2. As shown in Fig. 2, a real-time PCR analysis showed that the serum EBV-DNA level had rapidly decreased, and she regained consciousness.
Abdominal computed tomography before the initiation of rituximab. Abdominal computed tomography demonstrated hepatosplenomegaly, increased thickness of the gallbladder wall, and multiple enlarged abdominal lymph nodes.
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On Day 41, a computed tomography (CT) scan (Fig. 3) revealed hepatosplenomegaly, thickening of the gallbladder wall because of acute hepatitis, and enlargement of multiple abdominal lymph nodes.
Southern blot analysis demonstrated monoclonality of the EBV-infected cells. M' represents the size marker of the DNA; No. 1 is the positive control, No. 2 is the negative control, and No. 3 is the patient's peripheral blood sample.
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EBV-LPD was confirmed because of the monoclonality of EBV-DNA in her peripheral blood by Southern blotting hybridization (Fig. 4).
Cranial magnetic resonance imaging (MRI) fluid attenuation inversion recovery imaging. Cranial MRI fluid attenuation inversion recovery imaging revealed high-intensity lesions in the cerebral cortex, in keeping with a diagnosis of viral (EBV) encephalitis.
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Cranial T2-weighted MRI and fluid-attenuated inversion recovery (Fig. 5) showed high-intensity lesions in her cerebral cortex.
Abdominal computed tomography after the eight cycles of rituximab. A CT scan revealed that there was no evidence of hepatosplenomegaly, enlarged gallbladder, or abdominal lymphoadenopathy after treatment with rituximab.
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A CT scan also revealed that there was no evidence of hepatosplenomegaly, enlarged gallbladder, or abdominal lymphoadenopathy (Fig. 6).