A 16-year-old previously healthy boy is brought to the office due to fever, malaise, and sore throat. The patient says that he gets tired even by simply getting out of bed. Physical examination shows palatal petechiae, cervical lymphadenopathy, and splenomegaly. His peripheral blood smear is shown in the image below. Horse erythrocytes agglutinate when exposed to the patient's serum. The agent causing this patient's disease is most strongly associated with which of the following malignancies?

Question

A 16-year-old previously healthy boy is brought to the office due to fever, malaise, and sore throat.  The patient says that he gets tired even by simply getting out of bed.  Physical examination shows palatal petechiae, cervical lymphadenopathy, and splenomegaly.  His peripheral blood smear is shown in the image below.  Horse erythrocytes agglutinate when exposed to the patient's serum.  The agent causing this patient's disease is most strongly associated with which of the following malignancies?

Quizplus · Accepted Answer

11ec160b_3982_61da_9249_d7246603870f_MD0001_00 Sore throat, moderate to high fever, palatal petechiae, lymphadenopathy (commonly posterior cervical or auricular), splenomegaly, and atypical (reactive) lymphocytosis are classic signs and symptoms of infectious mononucleosis, a disease common among teenagers and young adults. Ninety percent of cases of infectious mononucleosis are caused by the Epstein-Barr virus (EBV); however, cytomegalovirus, HIV, and Toxoplasma are some of the other agents known to cause non-EBV infectious mononucleosis. EBV infection induces heterophile antibodies, which react to antigens from animal erythrocytes (sheep in the Paul-Bunnell test and horse in the Monospot test). The heterophile antibody tests are sensitive and specific for EBV-associated infectious mononucleosis. EBV replicates primarily in B lymphocytes and is also associated with malignancies, including Burkitt lymphoma (especially the endemic African type) and nasopharyngeal carcinoma. Many disorders in immunocompromised patients are caused by EBV, including central nervous system lymphoma in HIV-positive patients and post-transplant lymphoproliferative disorder (PTLD) in allograft recipients. (Choices A and F) There is no classic association between acute myeloid leukemia or multiple myeloma and viral infection. (Choice B) Cervical carcinoma is strongly associated with human papillomavirus (types 16, 18, 31, and 33) infection. (Choice C) Chronic infection with either hepatitis B or C virus significantly increases the risk of hepatocellular carcinoma. (Choice D) Kaposi sarcoma is strongly associated with HIV and human herpes virus type 8 infections. (Choice E) Gastric adenocarcinoma and mucosa-associated lymphoid tissue tumor (MALToma) are associated with Helicobacter pylori infection. Educational objective: Epstein-Barr virus causes infectious mononucleosis in teenagers and young adults. It is also associated with a number of malignant conditions, including Burkitt lymphoma and nasopharyngeal carcinoma.

A 16-Year-Old Previously Healthy Boy Is Brought to the Office