Detection of Epstein-Barr virus DNA in cardiac and aortic tissues from chronic, active Epstein-Barr virus infection associated with Kawasaki disease-like coronary artery aneurysms

Kikuta, Hídeaki; Sakiyama, Yukio; Matsumoto, Shuzo; Hamada, I; Yazaki, Makoto; Iwaki, Toshimitsu; Nakano, Masao

doi:10.1016/s0022-3476(05)81546-x

Cited by 60 publications

(38 citation statements)

References 10 publications

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“…More recently, they found the EBV genome in cardiac and aortic tissue samples from three cases of CAEBV, including the present case by means of the polymerase chain reaction. 8 We have reported a child with CAEBV accompanied by giant coronary artery aneurysms and aortic aneurysms. These aneurysms resulted from lymphoid vasculitis.…”

Section: Ebv Infectionmentioning

confidence: 96%

Chronic Active Epstein-Barr Virus Infection With Giant Coronary Aneurysms

Nakagawa¹,

Ito²,

Iwaki³

et al. 1996

Am J Clin Pathol

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Chronic active Epstein-Barr virus infection (CAEBV) is a nonfamilial syndrome that shows a specific immunodeficiency for the Epstein-Barr virus (EBV). Prolonged fever, hepatosplenomegaly, lymphadenopathy, and liver dysfunction were seen in CAEBV, but cardiac complications are rare. An autopsy case of CAEBV with giant coronary aneurysms and aortic aneurysms is reported. The patient was a 5-year-old Japanese girl. At autopsy, the heart weighed 110 g, and bilateral coronary aneurysms were found. Microscopic studies revealed lymphoid vasculitis of coronary arteries, coronary venules, and aortic arteries. ImmunoIn 1988, Kikuta and colleagues first reported the EBV genome-positive peripheral T lymphocytes in a child with CAEBV associated with coronary aneurysms.7 Although the coronary aneurysm was suspected to be due to EBV infection, the pathologic features and the relationship between coronary aneurysm and EBV infection are unclear. In this report, the coronary aneurysms resulting from panarteritis with infiltrating EBV genomepositive T lymphocytes are presented. This finding appears to be a part of systemic angiocentric EBV genomepositive T lymphocytes' infiltration in CAEBV. CASE REPORTA 5-year-old Japanese girl with no family history of immunodeficiency was admitted to Tajimi Prefectual Hospital in November 1991. She had been well until February 1991, when she developed a skin rash. At presentation, she had a 1-month history of continued fever and hepatosplenomegaly. The bilateral coronary aneurysms and dilatation of the sinus of Valsalva were detected by cross-section echocardiography, the diameter was 8 mm in the right coronary artery, 5 mm in the left coronary artery, and 38 mm in the sinus of Valsalva. Thoracic and abdominal aortic aneurysms were also seen. She had mild anemia, liver dysfunction, and hypergammaglobulinemia without evidence of monoclonality (IgG 2,263 mg/dL). No atypical lymphocytes were found in peripheral blood at presentation. Serologic evidence for Epstein-Barr virus (EBV)-related antibodies were demonstrated in Table 1. The serologic tests showed no evidence of acute infection with herpes virus type 1, cytomegalovirus, or measles virus. The 1.3% of peripheral B lymphocytes were positive for EBNA by anti-complement immunofluorescence test.' The natural killer-cell activity was normal. The clinical course is summarized in Figure 1. Treatment with acyclovir and interferon was instituted, but the child died 13 months after the onset of the disease due to acute respiratory failure. PATHOLOGIC FINDINGSThe heart weighed 110 g and the left ventricle was dilated. The bilateral coronary aneurysms were found. The left coronary artery and the Valsalva sinus were markedly dilated, at 2.5 cm and 4.5 cm in diameter, respectively (Fig. 2). Microscopic studies revealed marked lym-733 Downloaded from https://academic.oup.

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Section: Ebv Infectionmentioning

confidence: 96%

Chronic Active Epstein-Barr Virus Infection With Giant Coronary Aneurysms

Nakagawa¹,

Ito²,

Iwaki³

et al. 1996

Am J Clin Pathol

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“…Although, no bacteria or virus has been consistently found yet, an infectious cause is highly suspected (7). Some of the infectious agents proposed are Parvovirus (8), Staphylococcus aureus (9), Epstein-Barr virus (10), Chlamydia (11), and Mycobacteria (12). The occurrence of this condition in young children further corroborates this hypothesis.…”

Section: Etiologymentioning

confidence: 99%

Kawasaki Disease; A Review Article

Shiari

2013

Arch Pediatr Infect Dis

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“…Chronic active EBV infection (CAEBV) is characterized by chronic recurrent infectious mononucleosis-like symptoms over a long period of time and by an unusual pattern of anti-EBV-antibodies (1)(2)(3)(4)(5)(6). CAEBV is a disease with a high mortality with lifethreatening complications, such as virus-associated hemophagocytic syndrome, EBV-positive lymphoid neoplasia mainly in T-cell and natural killer (NK) cell lineage, interstitial pneumonia, cardiovascular diseases and large-vessel arteritis with infiltration of EBV-positive lymphoid cells (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…Affinity of EBV-infected lymphoid cells to large vessels involving coronary arteries, aorta, and its major branches has been reported, but not in small vessels (12)(13)(14)(15)(16)(17)(18). In this report, we describe occlusive vasculopathy of the small pulmonary arteries and arterioles in a patient with CAEBV associated with pulmonary arterial hypertension (PAH).…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Arterial Hypertension Associated with Chronic Active Epstein-Barr Virus Infection

et al. 2011

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A 45-year-old man with chronic active Epstein-Barr virus (EBV) infection (CAEBV) with natural killer cell type developed pulmonary arterial hypertension (PAH). After chemotherapy, he showed marked depression of the EBV DNA genome in the peripheral blood, but PAH sustained. He died of heart failure due to PAH, and the histo-pathological examination revealed pulmonary vascular abnormalities without lung disease on autopsy. Although the EBV DNA genome and the infiltrating lymphocytes were not detected in the lung, his clinical course suggested that his PAH might be caused by CAEBV. This is the first reported case of PAH associated CAEBV in an adult.

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Detection of Epstein-Barr virus DNA in cardiac and aortic tissues from chronic, active Epstein-Barr virus infection associated with Kawasaki disease-like coronary artery aneurysms

Cited by 60 publications

References 10 publications

Chronic Active Epstein-Barr Virus Infection With Giant Coronary Aneurysms

Chronic Active Epstein-Barr Virus Infection With Giant Coronary Aneurysms

Kawasaki Disease; A Review Article

Pulmonary Arterial Hypertension Associated with Chronic Active Epstein-Barr Virus Infection

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