Review of Primary Article

Successful Immunosuppressive Therapy for Severe Infectious Mononucleosis in a Patient with Clonal Proliferation of EBV-infected CD8-postive Cells 

This is a study conducted in 2015 and was published in Internal Medicine. The study focuses on a treatment for a rare form of mononucleosis. Normally, mononucleosis infects beta lymphocytes and other Epstein-Barr viruses (EBV) infect T-cells, which can result in death. It is important to decipher which lymphoid cells are being infected because that determines the type of treatment needed. Immunological responses to EBV-infected cells can cause organ damage and hemophagocytic lymphohistiocytosis (HLH). This can be treated with immunosuppressive therapy to reduce excessive immune response. Sometimes EBV-infected cells go through clonal proliferation leading to EBV-associated malignant lymphoma, which is treated with chemotherapy. Southern Blots are used to detect the clonal proliferation of infected cells. The clonal proliferation is a characteristic of malignancy and supports the indication for chemotherapy.

The researchers studied a case where a woman contained clonal proliferation EBV-infected T-cells that responded to immunosuppressive therapy instead of chemotherapy. A thirty year old woman was admitted to the hospital with a sore throat, fever, HLH, elevated lymphoid cells, and elevated liver enzymes. Based on these features she was diagnosed with mononucleosis; however, there was expansion in her CD8-postive T-cells indicating clonal proliferation. To further determine if the patient had mononucleosis or lymphoma, a biopsy was taken of her lymph nodes. It was determined that she was suffering from mononucleosis. She was treated with immunosuppressive therapy. This resulted in reduction of HLH, decrease in liver damage, and decrease in infected CD8-positive T-cells. After four months the EBV was undetectable in the cells and the antibody IgM titer became negative. This study concluded that clonal proliferation of CD8-positve T-cells doesn't always indicate malignant lymphoma and can be treated with immunosuppressive therapy instead of chemotherapy.

This is a table from the study demonstrating the positive effect immunosuppressive therapy had on the patient.

After reading this study, I suggest that scientists research other treatments that can effectively stop the clonal proliferation of CD8-positive T-cells. If further research is conducted on more treatments then there will be more options for treatment of extreme cases of mononucleosis and maybe even malignant lymphoma.