phenylephrine-hydrochloride and Epstein-Barr-Virus-Infections

Cavernous sinus (CS) lymphoma without paranasal sinuses involvement is extremely rare in pediatric population and remains a diagnostic challenge due to its similarity to other tumors located in this area. An 8-year-old boy presented with a 6-day history of gradually developing ptosis in the right eyelid. After admission, his symptoms progressed within 24 h to include right-sided ophthalmoplegia consisting of oculomotor and abducens nerve palsies. Endoscopic endonasal approach (EEA) was performed urgently to decompress the CS and to obtain a diagnosis. The postoperative course was uneventful, and there was no complication related to the surgical approach. No immunodeficiency was identified. The histopathological diagnosis was an Epstein-Barr virus (EBV)-positive high-grade mature B cell non-Hodgkin lymphoma. He was initiated chemotherapy according to COG ANHL01P1 protocol. Two months after surgery, the third and sixth nerve palsies had resolved completely. Currently, he is well and has no clinical or radiological recurrence. This is the first pediatric case with EBV-positive CS lymphoma that underwent EEA for the diagnosis and decompression. In the pediatric population, EEA enables minimally invasive access to the CS and can play an alternative role in the management of CS lesions, either through biopsy or debulking.

Topics: Cavernous Sinus; Child; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Humans; Lymphoma, B-Cell; Male; Nose

Topics: Antineoplastic Combined Chemotherapy Protocols; Arm; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Lymphoma, Extranodal NK-T-Cell; Middle Aged; Nasopharyngeal Carcinoma; Neoplasms, Multiple Primary; Nose; Positron-Emission Tomography; Skin

Epstein-Barr virus detection using nasopharyngeal swabs has been suggested as a potential screening test that could improve the specificity of current EBV-based serological assays. However, application requires insertion of the swab deep into the nasopharynx, a procedure not amenable to non-clinic screening. We reasoned that swabbing the more easily accessible nasal cavity might provide an appealing alternative for NPC detection. Patients > 18 years of age diagnosed with histologically confirmed NPC were recruited from the Otolaryngology Department at the National Taiwan University Hospital. ENT clinicians collected both nasal and nasopharyngeal swabs. EBV DNA and cellular beta-globulin DNA were quantified using quantitative PCR targeting a highly-conserved region of the BKRF1 gene. EBV DNA was detectable (non-zero) in all 34 nasopharyngeal swabs and above the positivity threshold of 1666 EBV copies in 30 (88.2%) patients. EBV DNA was detectable in 50% of 34 nasal swabs and above the positivity threshold in four (11.8%) patients. Average EBV DNA levels were >3-fold higher (P < 0.001) in nasopharyngeal compared to nasal swabs. Among the 17 NPC patients with detectable EBV DNA in both swab types, we observed correlation (P < 0.01) between EBV DNA measurements. Our data represent the first evaluation of EBV DNA collected from nasal swabs. Given current EBV DNA amplification techniques, nasopharyngeal swabs remain more sensitive than nasal swabs for NPC detection.

Topics: Adult; Aged; Antigens, Viral; Carcinoma; DNA, Viral; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Nose; Real-Time Polymerase Chain Reaction; Sensitivity and Specificity; Specimen Handling; Taiwan; Viral Load; Young Adult

Epstein-Barr virus (EBV) is related to the development of lymphomas and is also the etiological agent for infectious mononucleosis (IM). Sequence variation of the EBNA1 gene, consistently expressed in all EBV-positive cells, has been widely studied. Based on the amino acid at codon 487 five major EBNA1 variants have been described, two closely related prototypic variants (P-ala and P-thr) and three variant sequences (V-leu, V-val, and V-pro). Sub-variants were then further classified based on mutations other than the originally described. While several studies proposed associations with tumors and/or anatomical compartments, others argued in favor of a geographical distribution of these variants. In the present study, EBNA1 variants in 11 pediatric patients with IM and 19 pediatric EBV lymphomas from Argentina were compared as representatives of benign and malignant infection in children, respectively. A 3-month follow-up study of EBNA1 variants in peripheral blood cells and in oral secretions of patients with IM was performed. A new V-ala variant which includes five V-ala sub-variants and three new V-leu sub-variants was described. These data favor the geographical association hypothesis since no evidence for a preferential compartment distribution of EBNA1 variants and sub-variants was found. This is the first study to characterize EBNA1 variants in pediatric patients with infection mononucleosis worldwide.

Topics: Adolescent; Argentina; Blood; Bodily Secretions; Child, Preschool; Cluster Analysis; DNA, Viral; Epstein-Barr Virus Infections; Epstein-Barr Virus Nuclear Antigens; Female; Genotype; Herpesvirus 4, Human; Humans; Lymphocytes; Male; Molecular Epidemiology; Molecular Sequence Data; Nose; Phylogeny; Polymorphism, Genetic; Sequence Analysis, DNA

Topics: Antineoplastic Combined Chemotherapy Protocols; CD56 Antigen; Connective Tissue Diseases; Cyclophosphamide; Diagnostic Errors; Doxorubicin; Epstein-Barr Virus Infections; Eyelid Neoplasms; Fatal Outcome; Female; Herpesvirus 4, Human; Humans; Immunophenotyping; Killer Cells, Natural; Lymphoma, Non-Hodgkin; Lymphoma, T-Cell, Cutaneous; Male; Nose; Prednisolone; Skin; Skin Neoplasms; T-Lymphocyte Subsets; Vincristine; Young Adult