This is the first autopsy case of Epstein–Barr virus-positive marginal zone lymphoma (EBV + MZL) with an other iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPD) (methotrexate [MTX]-associated LPD) that deteriorated after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. This case had a unique immunophenotype. A 71-year-old female patient with rheumatoid arthritis receiving MTX presented with fatigue 1 week after the SARS-CoV-2 vaccination. She was hospitalized due to hepatorenal dysfunction and pancytopenia. Computed tomography revealed systemic lymphadenopathy. Her physical condition deteriorated, and the patient died. The autopsy revealed systemic lymphadenopathy comprising medium-sized atypical lymphocytes and scattered Hodgkin/Reed–Sternberg (H/RS)-like cells. An immunohistochemical examination showed that atypical lymphocytes were positive for CD79a and MUM-1 and some were positive for CD20 and IRTA-1. H/RS-like cells were immunoreactive for CD30 and CD15 and ringed by T cells. Both cell types were positive for EBV-encoded small RNA. The majority of H/RS-like cells were positive for CD20, whereas a small number of CD3-positive cells were admixed. We herein presented the first autopsy case of EBV + MZL that deteriorated after the SARS-CoV-2 vaccination.

中文翻译：

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首例尸检病例 Epstein-Barr 病毒阳性边缘区淋巴瘤在接种 COVID-19 疫苗后病情恶化

这是第一例 Epstein-Barr 病毒阳性边缘区淋巴瘤 (EBV + MZL) 合并其他医源性免疫缺陷相关淋巴组织增生性疾病 (LPD)（甲氨蝶呤 [MTX] 相关 LPD）的尸检病例，该疾病在严重急性呼吸综合征后病情恶化冠状病毒 2 (SARS-CoV-2) 疫苗。该病例具有独特的免疫表型。一名 71 岁女性类风湿关节炎患者接受 MTX，在接种 SARS-CoV-2 疫苗 1 周后出现疲劳。她因肝肾功能障碍和全血细胞减少症住院。计算机断层扫描显示全身淋巴结肿大。她的身体状况恶化，患者死亡。尸检显示全身淋巴结肿大，包括中等大小的非典型淋巴细胞和分散的霍奇金/里德-斯滕伯格（H/RS）样细胞。免疫组化检查显示异型淋巴细胞CD79a、MUM-1阳性，部分异​​型淋巴细胞CD20、IRTA-1阳性。H/RS 样细胞对 CD30 和 CD15 具有免疫反应性，并被 T 细胞包围。两种细胞类型的 EBV 编码小 RNA 均呈阳性。大多数H/RS样细胞CD20阳性，而少量CD3阳性细胞混合。我们在此介绍了第一例 EBV + MZL 尸检病例，该病例在接种 SARS-CoV-2 疫苗后病情恶化。