Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2020; 8(15): 3284-3290
Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3284
Natural killer/T-cell lymphoma with intracranial infiltration and Epstein-Barr virus infection: A case report
Nan Li, Yi-Zhuo Wang, Yi Zhang, Wei-Ling Zhang, Yan Zhou, Dong-Sheng Huang
Nan Li, Yi-Zhuo Wang, Yi Zhang, Wei-Ling Zhang, Yan Zhou, Dong-Sheng Huang, Pediatric Department, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100176, China
Author contributions: Li N collected and organized the data, and conceived and wrote the article; Wang YZ and Zhang Y did case analysis and revision of the paper; Zhang WL reviewed the article; Zhou Y collected the clinical data; Huang DS reviewed and consented of the article; all authors issued final approval for the version to be submitted.
Supported by the Beijing Hospital Authority "DengFeng" Talent Training Plan, No. DFL20180201.
Informed consent statement: Informed written consent was obtained from the patient’s guardian
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dong-Sheng Huang, PhD, Chief Doctor, Professor, Pediatric Department, Beijing Tongren Hospital Affiliated to Capital Medical University, No. 2 Xihuan South Road, Beijing Economic and Technological Development Zone, Beijing 100176, China. hds5180@sina.com
Received: December 25, 2019
Peer-review started: December 25, 2019
First decision: March 27, 2020
Revised: May 15, 2020
Accepted: July 22, 2020
Article in press: July 22, 2020
Published online: August 6, 2020
Processing time: 224 Days and 18.9 Hours
Abstract
BACKGROUND

Because of atypical clinical symptoms, lymphoma is easily confused with infectious diseases. Extranodal nasal-type natural killer/T-cell lymphoma (NKTL) is more common, and there are few cases of eyelid site onset and intracranial infiltration, which increases the difficulty of diagnosis. This disease usually has a very poor prognosis and there are few reports of recovery.

CASE SUMMARY

A 3-year-old boy was admitted to our hospital due to an initial misdiagnosis of "eyelid cellulitis" and failed antibiotic treatment. He was characterized by fever, right eyeball bulging, convulsions, and abnormal liver function. His blood Epstein-Barr virus (EBV) DNA was positive (8.798 × 104 copies/mL), and remained positive for about half a year. The cranial imaging examination suggested a space-occupying lesion in the right eyelid, with the right temporal lobe and meninges involved. The boy underwent ocular mass resection. The pathological diagnosis was NKTL. He was diagnosed as having NKTL with intracranial infiltration, combined with chronic active EBV infection (CAEBV). Then he underwent systemic chemotherapy and intrathecal injection. The boy suffered from abnormal blood coagulation, oral mucositis, diarrhea, liver damage, and severe bone marrow suppression but survived. Finally, the tumor was completely relieved and his blood EBV-DNA level turned negative. The current follow-up has been more than 2 years and his condition is stable.

CONCLUSION

This case suggests that chemotherapy combined with intrathecal injection may have a good effect on intracranial infiltrating lymphoma and CAEBV, which deserves further study and discussion.

Keywords: Natural killer/T-cell lymphoma; Intracranial infiltration; Chronic active Epstein-Barr virus infection; Eyelid cellulitis; Chemotherapy; Case report

Core tip: Natural killer/T-cell lymphoma (NKTL) is rare to see with the eyelid site onset and intracranial infiltration, which increases the difficulty of diagnosis and suggests a very poor prognosis. We present the case of a 3-year-old boy who was initially misdiagnosed with ocular cellulitis but finally diagnosed with NKTL with ocular involvement, intracranial infiltration, and chronic active Epstein-Barr virus infection. He achieved complete remission through chemotherapy. Ocular involvement and intracranial infiltration are rare in NKTL cases and are associated with a poor prognosis, but the boy responded well to chemotherapy, which deserves further study and discussion.