Epstein-Barr virus-positive aggressive lymphoma as a consequence of immunosuppression after multiple salvage treatments for follicular lymphoma

We report on a patient with follicular non-Hodgkin's lymphoma (NHL) who dev eloped a fatal high-grade Epstein-Barr virus (EBV)-positive NHL after conve ntional chemotherapies. The sudden onset of the high-grade lymphoma was acc ompanied by increasing circulating EBV genome copies and was complicated by spontaneous rupture of the spleen. Splenic tissue was diffusely infiltrate d by large B cells. In situ hybridization for Epstein-Barr-encoded RNA (EBE R) 1-2 was positive in 70% of cells, and molecular analysis revealed the pr esence of EBV DNA and a monoclonal IgH gene rearrangement. This case shows that the immunosuppression of multiple treatments may induce uncontrolled r eactivation of a latent EBV infection, contributing to high-grade transform ation in heavily treated lymphoma patients.