From: Stetler-Stevenson, Maryalice (NIH/NCI) (stetler@mail.nih.gov)
Date: Tue Nov 19 2002 - 11:22:40 EST
We have observed transient clonal t-Cell and B-cell populations in patient's that we have watched disappear. However, some clones do progress. I would recommend following this patient by CBC and repeat flow in a few months if possible for completeness. Maryalice Stetler-Stevenson Chief, Flow Cytometry Unit Laboratory of Pathology, NCI, NIH Sometimes you're the windshield, sometimes you're the bug. > ---------- > From: Bee Christopher S Maj 859 MDTS/MTLLI > Sent: Friday, November 15, 2002 11:27 > To: Cytometry Mailing List > Subject: Interesting T-cell case > > > I was looking for thoughts/opinions on a recent flow cytometry case. The > case is that of a 38 year old male who presented with vague complaints, > fever, and malaise that was thought to have a possible viral/infectious > etiology. During his brief admission, a CBC was reviewed due to the > presence > of leukocytosis (WBC-17,300/ul) with an absolute lymphocytosis (68% > lymphocytes). Many of the lymphocytes were reactive/atypical, similar to > those often seen with EBV infection. A Monospot was negative. > > Flow cytometry performed on the peripheral blood showed 92% T cells, 7% NK > cells and <1% B cells. Of interest, there was a marked predominance of CD8 > (85%) and loss of expression of CD7. CD4 was present on 15% of cells and > CD2, CD3, and CD5 were present in expected numbers with normal intensity. > Because of the unusual loss of CD7 and predominance of CD8, the specimen > was > sent for PCR for TCR-gamma which apparently preliminary shows a clonal > rearrangement. > > In the course of the patient's admission, the patient was found to be HIV > positive (new diagnosis) and also had serologies suggestive of acute > infection with CMV. EBV serologies were negative. The above-described flow > findings have been well-described with EBV infection. In fact, in one of > the > recent articles on the Flow Cases Web site (www.flowcases.org), similar > findings are described for a child with acute EBV infection. This child > also > had a positive clonal T cell rearrangement which subsequently disappeared > along with the abnormal flow findings when the infection had cleared. > > Has anyone seen similar findings with either HIV and/or CMV infection. If > so, should the patient be followed with repeat flow and/or molecular > studies > during the course and management of his newly diagnosed infection. Thanks > for your thoughts. > > Christopher S. Bee, M.D. > Medical Director, Flow Cytometry > Wilford Hall Medical Center > San Antonio, TX > (210) 292-5455 > >
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