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April 2, 1982

Fatal Lymphohistiocytic Proliferation Owing to Epstein-Barr Virus-Reply

JAMA. 1982;247(13):1811. doi:10.1001/jama.1982.03320380017016

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In Reply.—  Drs Purtilo and Johnson suggest that EBV infection in an immune deficient XX/XY chimeric host could have led to the fatal lymphohistiocytic proliferation in our patient, analogous, perhaps, to the XLP. They base their suggestion on the high incidence of XX/XY chimerism in marmosets, which are also susceptible to EBV-induced lymphoproliferative disease. While this possibility is intriguing, there is no anamnestic or laboratory indication of a previous immune deficiency or EBV infection in our patient. The titer of anti-EBV-VCA antibodies, tested twice in the initial phase of the disease, IgG 1:128 and IgA negative, did not indicate a recent EBV infection. Nevertheless, we gratefully accept the suggestion of Drs Purtilo and Johnson to probe for the virus in tissues with the new techniques mentioned in their letter.