A Clinicopathological Study of Cytomegalovirus Lymphadenitis and Tonsillitis and Their Association with Epstein-Barr Virus

Intractable Pruritus as Initial Presentation of Cytomegalovirus -Tuberculosis Coinfections

Coinfection of cytomegalovirus (CMV) and Mycobacterium tuberculosis presenting with acquired perforating dermatosis is a rare occurrence and remains poorly described in the literature. A man in his 40s, a farmer and chronic smoker, who was partially treated for tuberculosis, presented with a history of fever, weight loss, cough, generalized lymphadenopathy, severe pruritus, and skin lesions. Imaging findings suggested tuberculosis, which was confirmed by sputum examination. Histopathological examinations confirmed CMV lymphadenitis associated with acquired perforating dermatosis. Treatment included antitubercular therapy and a multidrug regimen for severe pruritus, leading to symptomatic improvement. Despite initial progress, the patient was lost to follow-up and later succumbed at home, emphasizing the importance of timely intervention for coinfected tuberculosis and cytomegalovirus diseases. This case highlights the rarity of cytomegalovirus and tuberculosis coinfection, the diagnostic complexities, the challenges associated with the treatment of intractable pruritus, and the necessity of ensuring proper follow-up.

Cytomegalovirus Lymphadenitis Mimicking Hodgkin Lymphoma Relapse

Cytomegalovirus (CMV) reactivation is a known complication in patients with hematological cancers and those who undergo stem cell transplants, often resembling cancer relapse. CMV lymphadenitis, an infection localized to the lymph nodes, can be difficult to distinguish from lymphoma recurrence based on clinical and radiological findings alone. We report a case of a 40-year-old male treated for Hodgkin lymphoma who presented with cervical lymphadenopathy nine months after treatment. PET-CT showed a hypermetabolic lesion, suggesting relapse, but a biopsy confirmed CMV lymphadenitis. Systemic CMV infection was excluded based on negative PCR results and normal thoracic imaging. This report highlights the importance of histopathological confirmation in patients with a history of lymphoma, as CMV lymphadenitis can mimic relapse. Accurate diagnosis prevents unnecessary treatments and avoids misinterpretation of imaging findings. In isolated lymph node cases without systemic symptoms, observation may be sufficient as the condition can resolve spontaneously. This underscores the need for careful evaluation to ensure correct diagnosis and appropriate management.

Nodal reactive proliferation of monocytoid B-cells may represent atypical memory B-cells

BACKGROUND

Reactive lymphadenopathies such as toxoplasmosis and cytomegalovirus lymphadenitis are associated with monocytoid cell proliferation. Monocytoid cells are B-lymphocytes with an undetermined subset.

METHODS

Using digital spatial profiling whole transcriptome analyses, this study compared monocytoid and control B-cells. The B-cell subset of monocytoid cells was assigned according to gene expression profiles.

RESULTS

This study identified 466 differentially expressed genes between monocytoid and control B-cells. The cellular deconvolution algorithm identified monocytoid cells as memory B-cells instead of as naïve B-cells. A comparison of the upregulated genes revealed that atypical memory B-cells had the largest number of genes overlapping with monocytoid cells compared with other memory B-cell subsets. Atypical memory B-cell markers, namely TBX21 (T-bet), FCRL4 (IRTA1), and ITGAX (CD11c), were all upregulated in monocytoid cells. Similar to atypical memory B-cells, monocytoid cells exhibited (1) upregulated transcription factors (TBX21, TOX), (2) upregulated genes associated with B-cell inhibition (FCRL5, FCRL4) and downregulated genes associated with B-cell activation (PIK3CG, NFKB1A, CD40), (3) downregulated cell cycle-related genes (CDK6, MYC), and (4) downregulated cytokine receptors (IL4R). This study also analyzed the expression of monocytoid cell signature genes in various memory B-cell subsets. Atypical memory B-cells exhibited a gene expression pattern similar to that of monocytoid cells, but other memory B-cell subsets did not. Furthermore, monocytoid cells and marginal zone lymphomas differed in gene expression profiles.

CONCLUSION

Spatial transcriptomic analyses indicated that monocytoid cells may be atypical memory B-cells.

Cytomegalovirus lymphadenitis mimicking a relapsed diffuse large B-cell lymphoma

Cytomegalovirus (CMV) reactivation is frequent after autologous stem cell transplantation (ASCT), but generalized CMV lymphadenitis is rare. We report a CMV lymphadenitis after an ASCT mimicking a relapse of a diffuse large B-cell lymphoma. After histopathological documentation, CMV lymphadenitis should be treated to avoid systemic progression.