EBV(+) B-cell lymphoproliferative disorder associated with subsequent development of Burkitt lymphoma in a patient with idiopathic CD4(+) T-lymphocytopenia.

We report here a case of idiopathic CD4(+) T-lymphocytopenia (ICL) associated with Epstein-Barr virus (EBV)(+) lymphoproliferative disorder (LPD) terminating in Burkitt lymphoma (BL). A 33-year-old Japanese male was admitted to the hospital showing severe CD4(+) lymphocytopenia and neutropenia that was diagnosed as ICL in 1993. Twenty months after the onset of disease, right cervical lymphadenopathy was detected. Biopsy of the specimen showed reactive lymph node hyperplasia and interfollicular B-cell hyperplasia. Ninety-one months later, polypoid tumors were resected from the bilateral nasal cavities and were diagnosed as BL. Immunohistological studies suggested the reactive nature of the initial lymph node biopsy specimen. Polymerase chain reaction (PCR) analyses of immunoglobulin heavy-chain gene (IgH) demonstrated a polyclonal pattern in the initial lymph node lesion. However, the subsequent BL demonstrated a clonal band in the PCR assay for the IgH gene. As demonstrated in human immunodeficiency virus (HIV)-patients, clonal expansion of EBV infected B-cells in the initial lymph node lesion may progress to BL in this patient. The present case did not associate with severe opportunistic infections during the course of disease. EBV(+) BL may be the first manifestation of severe immunodeficiency of the ICL in this patient.