Emperipolesis, Apoptosis and Hemophagocytosis during Acute Epstein-Barr Virus (EBV) infection: A Case Report

Abstract

An eight-year-old patient had intermittent high grade fever and pharyngitis since one week. Later, he developed left-sided cervical lymphadenitis. Subsequently, he also developed palatal petechiae. Absolute lymphocyte count (ALC) was raised (ALC 20,262 cells/mm³). Hepatosplenomegaly was also detected. Clinically, the current case was diagnosed as a case of infectious mononucleosis. Possibility of infection by Epstein-Barr virus was considered. FNAC was done. Blood-mixed aspirate showed monocytoid cells with mild pleomorphic nuclei, and clumped chromatin. Inconspicuous nucleoli and abundant eosinophilic cytoplasm were seen. Foci of apoptosis were also seen. Frequent mitoses were seen. Findings were suggestive of acute reactive lymphocytic hyperplasia with hemophagocytosis and apoptosis. EBV DNA was detected by RT PCR with linear reporting range of 3.3×104 IU/ml. Herewith, we describe a case of infectious mononucleosis with emperipolesis and hemophagocytosis. Keywords: Epstein-Barr virus associated hemophagocytosis syndrome (EBVAHS).