[Case Reports] Epstein-Barr virus-associated T-cell lymphoma presenting as intractable gastric ulcers due to the vascular wall invasion 4 months before cervical nodal mass formation

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publisherMaekura, Syunnji : Otiai, Ken[Abstract] We report here a 75-year-old male in whom fever and gastric perforation due to multiple gastric ulcers developed 4 months before the development of cervical lymph node swelling. At the time of disease onset, he did not show the characteristics patterns of anti-Epstein-Barr virus (EBV) antibody responses with raised antiviral capsid (VCA) and anti-early antigen (EA) antibodies. He was diagnosed with chronic active EBV infection (CAEBV) based on an increased EBV-DNA level in the peripheral blood. Four months later, biopsy specimen of the swollen lymph nodes revealed the infiltration of clonal lymphoma cells positive for CD3, CD8, Tcell-restricted intracellular antigen 1 (TIA-1), and EBV-encoded RNA (EBER). He died of progressive infection with cytomegalovirus and invasive aspergillus and intractable multiple hemorrhagic gastric ulcers. The cause of the multiple gastric ulcers could not be identified before death. Autopsy revealed the infiltration of CD8-positive T cells with the same surface phenotypes as those of the cervical malignant lymphoma to the perivascular areas of the ulcer base and necrotic vasculitis. This case suggested that EBV-associated T-cell lymphoma can cause gastric wall infiltration and organ injury without forming an extranodal mass even 4 months earlier than the formation of nodal lesions.