Regression of uterine cervical diffuse large B-cell lymphoma transformed from mucosa-associated lymphoid tissue lymphoma subsequent to Chlamydia trachomatis eradication.

A 37-year-old-woman was referred to our center after her uterine cervix health screening presented abnormal findings. We performed a biopsy of the uterine cervix to examine for cervical dysplasia, and diagnosed a diffuse large B-cell lymphoma transformed from mucosa-associated lymphoid tissue (MALT) lymphoma of the cervix. The patient presented with concurrent chlamydial cervicitis and received eradication therapy for Chlamydia trachomatis. Four months later, the CD20 positive abnormal lymphocyte disappeared and complete remission was achieved. MALT lymphoma is considered to correlate with infection and inflammation. Particularly, the relationship between gastric MALT lymphoma and Helicobacter pylori is well known. MALT lymphoma of the uterine cervix is rare, and its relationship with C.trachomatis infection is unknown. Further studies are warranted to investigate this association.

Severe Colitis Associated with both Epstein-Barr Virus and Cytomegalovirus Reactivation in a Patient with Severe Aplastic Anemia.

Epstein-Barr virus (EBV) and cytomegalovirus (CMV) are members of the herpesvirus family and common causes of viral infection in humans. CMV infection of the gastrointestinal tract occurs mainly in immunocompromised individuals, on the other hand EBV infection and reactivation involving the gastrointestinal tract is very rare. A 56-year-old man was diagnosed with severe aplastic anemia and treated with antithymocyte globulin (ATG) and cyclosporine (CSP). After 2 years of ATG/CSP therapy, he suddenly started passing bloody diarrhea and developed a high fever despite CSP treatment. Endoscopic features included severe edema and multiple superficial ulcers; the patient was initially diagnosed with severe colitis resembling inflammatory bowel disease (IBD). However, his symptoms did not resolve with steroid treatment. Immunohistochemical analysis of samples obtained from a second colonoscopy showed cells positive for CMV, and in situ hybridization revealed EBV-encoded small RNA-1-positive cells. Additionally, the patient's serum was positive for C7-HRP, and both blood and colon tissues were positive for EBV DNA, which was detected using PCR analysis. We finally diagnosed the patient with colitis associated with reactivation of both CMV and EBV. The patient remains diarrhea-free after 1.5 years with scheduled globulin treatment and after cessation of immunosuppressive drug therapy. To our knowledge, this is the first reported case of an immunodeficient patient with severe hemorrhagic colitis that was associated with reactivation of both EBV and CMV, and whose endoscopic findings mimicked IBD.