[CIS-PAGID] Puzzling Patient #1

[Church, Joseph]

This 18yo girl had persistent anterior cervical adenitis complicating severe purulent tonsillitis.  Throat culture was negative for bacterial pathogens.  Routine serology for EBV and CMV were negative.  There was no organomegaly or adenopathy other than that described.

Eventually she came to biopsy that showed necrotizing adenitis with strong histochemical staining for EBV.  Histologic and histochemical features were not consistent with neoplasm.

EBV serology 1 month after the procedure showed only +EBV VCA IgM; 3 months after the procedure the serologic picture was the same.

Blood PCR for EBV was negative x2.

The following immune functions were normal:
            T-, B-, NK cell numbers.
            Ig levels
            Antibody responses to Pneumovax
            Mitogen and antigen-specific LPAs
            CTL function (Cincinnati Children's Lab)
            NK cell function (Cincinnati Cildren's Lab)
            X-inactivation - random (looking for potential for XLP)

Have any of you seen 4+ EBV in a lymph node with negative VCA IgG and EBNA and negative blood EBV PCR?

What am I missing?

Joe Church
Children's Hospital Los Angeles


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