Epstein-Barr virus-associated Hodgkin's disease in HTLV-I seropositive patients: A report of two cases

Diagnosis of Hodgkin's disease (HD) is quite difficult in the patient with seropositlvlty for human T cell lymphotropic virus I (HTLV-I). Herein, two cases of Epstein-Barr virus (EBV)-associated HD, which occurred In males with seropositlvity for anti-HTLV-l, are reported. One patient is alive and was diagnosed as having interfollicular HD with CD20⁺CD15^-CD30^-CD3^-CD4^-CD8^-CD45RO^-Reed-Stern-berg (R-S) cells. Positivity for EBV-encoded RNA1 (EBER-1) and latent membrane protein 1 (LMP-1) was shown on folllcular germinal center cells and R-S cells. In that case, neither T cell receptor (TCR) β chain rearrangement nor integration of the HTLV-I provlrus was demonstrated In the lymph nodes, although atyical lymphocytes (2%) were found in the peripheral blood. The other case pursued an aggressive clinical course and the patient was diagnosed as having an adult T cell leukemla/lymphoma (ATLL) because of the presence of antl-HTLV-l antibody, lymph node swelling, and the appearance of flower-like cells in the peripheral blood. However, an autopsy revealed no obvious ATLL cell infiltration in any of the organs examined. Multiple granulomatous lesions were found In the bone marrow, liver, kidneys, spleen, and lymph nodes. Reassessment of lymph node lesions In biopsies and granulomatous lesions in autopsy samples demonstrated that both lesions contained CD15⁺CD30⁺CD3^-CD4^-CD8^-CD20^-CD45RO^-EBER-1⁺LMP-1⁺R-S cells, and they were considered to be a composite lymphoma of HD and ATLL. These two cases therefore suggest that EBV-associated HD can develop in patients with seropositivity for HTLV-I.