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Fatal Epstein-Barr Virus Infection in a Child With Acute Lymphoblastic Leukemia in Remission¹

St. Jude Children's Research Hospital [A. T. L., R. F. N., T. C.] and University of Tennessee Center for the Health Sciences [H. G. H.], Memphis, Tennessee 38101, and the Joseph Stokes, Jr., Research Institute, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104 [W. H.]

A 9-year-old white boy developed a fatal primary Epstein-Barr virus (EBV) infection while receiving chemotherapy for acute lymphoblastic leukemia in remission. Histopathological findings at the height of the proliferative phase of the illness were compatible with a virally induced hemophagocytic syndrome. The infection spontaneously converted to complete aplasia of the bone marrow and lymph nodes. Serological studies disclosed that the patient had no antibodies to EBV prior to the infection, but during the acute phase he showed a spectrum and titers of antibodies to EBV-specific antigens characteristic of a current primary EBV infection. A lymph node biopsy obtained 5 weeks after onset revealed Epstein-Barr nuclear antigen in approximately 50% of the cells. The boy's condition deteriorated rapidly, with disseminated candidiasis resulting in cardiorespiratory failure and death. Lymph nodes obtained at autopsy no longer contained Epstein-Barr nuclear antigen-positive cells.

¹ This work was supported in part by USPHS Grants CA-21765 and CA-20180, Contract N01-CP-33272 from the National Cancer Institute, and by American Lebanese Syrian Associated Charities.

² To whom requests for reprints should be addressed, Division of Hematology Oncology, St. Jude Children's Research Hospital, P. O. Box 318, Memphis, Tenn. 38101.

Received 11/20/80. Accepted 3/ 4/81.