TY - JOUR
T1 - Postsplenectomy cytomegaloviral mononucleosis
T2 - Marked lymphocytosis, TCRγ gene rearrangements, and impaired IgM response
AU - Han, Xiang Y.
AU - Lin, Pei
AU - Amin, Hesham M.
AU - Ferrajoli, Alessandra
PY - 2005/4
Y1 - 2005/4
N2 - People who have undergone splenectomy mount a poor IgM response to bacterial polysaccharide vaccines. Whether this defect is true during natural bacterial and viral infections is unknown. We present 2 cases of postsplenectomy cytomegalovirus (CMV)-induced mononucleosis with impaired IgM but normal to augmented IgG response. The cases presented initial diagnostic challenges owing to a prolonged course of infection, marked lymphocytosis (peak lymphocyte count, 27,900/μL [27.9 × 109/L]), clonal T-cell proliferation with T-cell receptor γ gene rearrangements, and remote history of splenectomy. However, the acute nature of the infections, serial determinations of the anti-CMV IgM and IgG, exclusion of other causes, and detection of CMV in the blood established the diagnosis and revealed the deranged antibody response. The infections resolved without specific treatment. These cases suggest that the spleen might be a primary site for specific anti-CMV IgM response.
AB - People who have undergone splenectomy mount a poor IgM response to bacterial polysaccharide vaccines. Whether this defect is true during natural bacterial and viral infections is unknown. We present 2 cases of postsplenectomy cytomegalovirus (CMV)-induced mononucleosis with impaired IgM but normal to augmented IgG response. The cases presented initial diagnostic challenges owing to a prolonged course of infection, marked lymphocytosis (peak lymphocyte count, 27,900/μL [27.9 × 109/L]), clonal T-cell proliferation with T-cell receptor γ gene rearrangements, and remote history of splenectomy. However, the acute nature of the infections, serial determinations of the anti-CMV IgM and IgG, exclusion of other causes, and detection of CMV in the blood established the diagnosis and revealed the deranged antibody response. The infections resolved without specific treatment. These cases suggest that the spleen might be a primary site for specific anti-CMV IgM response.
KW - Cytomegalovirus
KW - IgM response
KW - Splenectomy
KW - TCRγ gene
UR - http://www.scopus.com/inward/record.url?scp=15744366107&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=15744366107&partnerID=8YFLogxK
U2 - 10.1309/HLBBK8V0A6T8BYV8
DO - 10.1309/HLBBK8V0A6T8BYV8
M3 - Article
C2 - 15743745
AN - SCOPUS:15744366107
SN - 0002-9173
VL - 123
SP - 612
EP - 617
JO - American journal of clinical pathology
JF - American journal of clinical pathology
IS - 4
ER -