Epstein-Barr virus-associated lymphoproliferative disorders after BNT162b2 mRNA COVID-19 vaccination

TANAKA Akane, KAWAGUCHI Takeharu, IMADOME Ken-Ichi, HARA Satoru

doi:10.11406/rinketsu.64.277

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BNT162b2 mRNA COVID-19ワクチン接種後に発症したEBウイルス関連リンパ増殖性疾患
BNT162b2 mRNA COVID-19ワクチン接種後に発症したEBウイルス関連リンパ増殖性疾患 : 第16回日本血液学会関東甲信越地方会優秀演題
BNT162b2 mRNA COVID-19 ワクチンセッシュゴニハッショウシタ EB ウイルスカンレンリンパゾウショクセイシッカン : ダイ16カイニホンケツエキガッカイカントウコウシンエツチホウカイユウシュウエンダイ

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Abstract

<p>Epstein-Barr virus-associated lymphoproliferative disorders (EBV-LPD) is a rare disease characterized by persistent or recurrent inflammation accompanied by EBV infection of T or NK cells that is not self-limiting, and it is fatal, if untreated. After receiving the first dose of the BNT162b2 mRNA COVID-19 vaccine, a 79-year-old male presented to the hospital with a 2-week history of fever. Laboratory results indicated pancytopenia, elevated liver transaminase levels, hyperferritinemia, and hypofibrinogenemia. Computed tomography revealed hepatosplenomegaly, but lymphadenopathy was not observed. A bone marrow biopsy, a random skin biopsy, and a liver biopsy revealed no malignancy, but an infectious evaluation revealed EBV viremia (5.19 Log IU/ml). Flow cytometry and RT-PCR revealed that the EBV genome was localized in NK cells, suggesting the diagnosis of EBV-NK-LPD. We administered prednisolone, intravenous immunoglobulin, and etoposide, but the EBV-DNA load failed to decrease, and he died 2 months later. Recently, case reports of COVID-19 vaccination-related hemophagocytic lymphohistiocytosis have been published. Although the mechanisms and risk factors for EBV-LPD after BNT162b2 mRNA COVID-19 vaccination remain unknown, it is important to note the possibility of reactivation of EBV after COVID-19 vaccination to initiate early and targeted therapy.</p>

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Rinsho Ketsueki

Rinsho Ketsueki 64 (4), 277-282, 2023

The Japanese Society of Hematology

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