T-gamma gene rearrangement and CMV mononucleosis

A clonal T-gamma rearrangement was found in peripheral blood and bone marro w in a 57-year-old female who presented with 6-week history of fevers, nigh t sweats, and weight loss. Splenomegaly, hemolytic anemia, atypical lymphoc ytosis, a marrow lymphoid aggregate, and elevated LDH had suggested lymphop roliferative disease. However, IgM serology for cytomegalovirus (CMV) was p ositive. With observation alone, her clinical features improved over 4 week s with normalization of the blood count and disappearance of CMV viremia an d the aberrant T-gamma clone. Acute CMV infection may mimic lymphoprolifera tive disease. T-gamma gene rearrangement may be part of the immune response to CMV infection and is not specific to lymphoid neoplasia. (C) 2001 Wiley -Liss, Inc.