Successful Treatment of Chronic Active Epstein-Barr Virus Infection Complicated by Cardiomyopathy in an Adult Patient

Figure 1.. Initial imaging findings. (a) Chest radiography showing cardiomegaly. (b) Contrast-enhanced CT images of the chest. The yellow arrows indicate pericardial effusion, and the yellow arrowheads represent splenomegaly. (c) PET/CT images. The red arrow depicts the nodular FDG uptake in the left ventricle, and the red arrowheads suggest a faint FDG uptake in the spleen.

Figure 2.. Histopathological examinations of the spleen and myocardium. (a) Histology of the spleen: Hematoxylin and Eosin (H&E) staining at low (×40, upper left) and high (×200, upper right) magnifications. Immunohistochemistry for CD3 (×200, lower left) and EBER (×200, lower right). (b) Histology of the myocardium: H&E staining at low (×40, upper left) and high (×200, upper right) magnifications. Immunohistochemistry for CD3 (×200, lower left) and EBER (×200, lower right).

Figure 3.. Clinical course of the patient with CAEBV and long-term follow-up of EBV-DNA. (a) Clinical course of the patient with CAEBV. The black arrow indicates chemotherapy with high-dose cytarabine, dexamethasone, and etoposide. The gray arrows suggest the Capizzi regimen, comprising high-dose cytarabine, L-asparaginase, and prednisolone. The white rectangular bars represent donor chimerism. The gray squares indicate the EBV-DNA load. The white triangles depict the left ventricular ejection fraction (LVEF). (b) Long-term follow-up of EBV-DNA. The white arrow represents the Southern blot test results. The black arrow indicates the PET/CT findings. PSL: prednisolone, HC: hydrocortisone, CyA: cyclosporine A, CBT: cord blood transplantation, EBV: Epstein-Barr virus, LVEF: left ventricular ejection fraction