fibrin and Bone-Marrow-Diseases

Topics: Adult; Bone Marrow Diseases; Epstein-Barr Virus Infections; Female; Fibrin; Granuloma; Humans

We previously reported 24 cases of marrow fibrin-ring granuloma (FRG) encountered in 1 institution and concluded that, contrary to previous studies showing marrow FRG as a diagnostic marker for Q fever, Epstein-Barr virus (EBV) was the most common proven cause of such FRG. The present study characterized patients with EBV-associated marrow FRG. We retrospectively reviewed 17 cases of EBV-associated FRG (43% of 40 cases with marrow FRG) diagnosed by bone marrow biopsy. Patients with EBV-associated hemophagocytic lymphohistiocytosis (5/17 patients) and chronic active EBV infection (4/17) constituted 53% of patients with EBV-associated FRG. Three patients had lymphoma without marrow involvement. All patients except 1 presented first with fever; splenomegaly was the next most common clinical finding (12/17). Cytopenia was observed in the 17 cases: anemia in 16, thrombocytopenia in 9, and leukopenia in 8. Patients with EBV-associated FRG showed lower survival outcomes than did patients without EBV (median, 3.0 vs 11.8 months; P = .009). Patients with bone marrow FRG accompanied by fever require careful evaluation to discern whether active EBV infection is involved because the prognosis is poor.

Topics: Adult; Aged; Bone Marrow Diseases; Child; Child, Preschool; Epstein-Barr Virus Infections; Female; Fibrin; Granuloma; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Prognosis

Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma.. We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group.. The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05).. Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.

Topics: Adolescent; Adult; Aged; Bone Marrow Diseases; Child; Child, Preschool; Epstein-Barr Virus Infections; Female; Fibrin; Granuloma; Herpesvirus 4, Human; Humans; In Situ Hybridization; Male; Middle Aged; Polymerase Chain Reaction; Prognosis; Q Fever; Retrospective Studies; Survival Rate

Topics: Acetaminophen; Aged; Analgesics, Non-Narcotic; Antibodies, Heterophile; Bone Marrow Diseases; CD4-CD8 Ratio; Female; Fibrin; Granuloma; Humans

Fibrin ring granulomas of the bone marrow are described in two organ transplant patients (one renal, one cardiac) with disseminated cytomegalovirus infection. Infection was documented by viral cultures and seroconversion, and in both cases typical cytomegalic cells were identified in proximity to the fibrin ring granulomas. These represent the first case reports of bone marrow fibrin ring granulomas associated with cytomegalovirus.

Topics: Bone Marrow Diseases; Cytomegalovirus Infections; Fibrin; Granuloma; Humans; Male; Middle Aged