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A 14-year-old girl experienced various toxicities and lack of efficacy while undergoing treatment for different conditions. She developed osteonecrosis during treatment with prednisone for oral mucositis, and experienced dysuria, vaginal spotting, vaginal dryness, and hot flashes during treatment with leuprorelin. Additionally, she did not respond well to treatment with colchicine, ciclosporin, and etanercept for erythema multiforme. The girl's symptoms improved after being transitioned to low progesterone containing oral contraceptive pills combined with upadacitinib. [Extracted from the article]

A 28-year-old woman experienced a recurrence of acquired acute genital ulceration after receiving the tozinameran (PfizerBioNTech COVID-19) vaccine. The woman had a history of genital ulceration associated with an Epstein-Barr virus infection when she was 16 years old. She presented with painful lesions on her labia minora and majora two days after receiving the second dose of the vaccine. Laboratory tests showed elevated white blood cell count and C-reactive protein levels. The woman was treated with various medications and her symptoms improved over the following weeks. It was concluded that the recurrence of genital ulceration was due to the vaccine. [Extracted from the article]

A 58-year-old woman developed neutropenia and drug-induced liver injury (DILI) while being treated with mesalazine for ulcerative colitis. She had a history of cytomegalovirus and Epstein-Barr virus infections. After starting mesalazine, she developed neutropenia and later liver enzyme elevation, leading to hospitalization. The woman's condition improved after discontinuing mesalazine, receiving ursodeoxycholic acid and glycyrrhizin, and undergoing treatment with vedolizumab. She was discharged with improved liver function and continued to be followed up on an outpatient basis. [Extracted from the article]

A 61-year-old man experienced various toxicities during his treatment for monophasic synovial sarcoma. He developed Epstein Barr virus-positive lymphoproliferative disorder, cytokine release syndrome, and immune effector cell-associated neurotoxicity syndrome while receiving cyclophosphamide, fludarabine, and afamitresgene-autoleucel. He also experienced rhabdomyolysis, Cytomegalovirus reactivation, and a non ST-segment elevation myocardial infarction while being treated with trabectedin. Despite multiple treatments, the patient exhibited lack of efficacy. However, there were some positive responses to certain treatments, such as partial response to granulocyte-colony-stimulating-factors and resolution of pulmonary and pleural lesions with trabectedin. [Extracted from the article]

A literature study examined 5006 patients who received solid organ transplantation between January 1984 and December 2015. The study found that female infants developed Epstein-Barr virus associated smooth muscle tumors during immunosuppressive therapy with various drugs, including antithymocyte-globulin, tacrolimus, mycophenolate mofetil, prednisone, and ciclosporin. Additionally, some infants experienced drug intolerance during treatment with gemcitibine and docetaxel. Lack of efficacy was also observed during treatment with vincristine, doxorubicin, cyclophosphamide, unspecified steroids, and famiciclovir for Epstein-Barr virus associated smooth muscle tumors or Epstein-Barr virus infection. The specific details of the treatments and outcomes were not provided in the study. [Extracted from the article]

A 27-year-old woman with chronic active Epstein-Barr virus infection experienced a lack of efficacy during treatment with aciclovir, bortezomib, ganciclovir, prednisolone, and rituximab. Despite receiving these medications, her condition worsened, leading to acute respiratory failure and severe symptoms of encephalitis. The lack of effectiveness of the medications prompted her admission to a transplant center, where she underwent allogeneic stem cell transplantation and received EBV-Specific T Cells. This case highlights the challenges in treating Epstein-Barr virus infection and the need for alternative therapies. [Extracted from the article]

A retrospective study analyzed 24 patients who were treated with off-label cyclophosphamide, fludarabine, and rituximab for a bone marrow conditioning regimen. Two patients experienced reactivation of cytomegalovirus infection or Epstein-Barr virus infection as a result of the treatment. The study did not provide specific details about the patients' ages, genders, dosages, routes of administration, time to reaction onset, or outcomes. [Extracted from the article]

A 78-year-old woman developed cutaneous lymphomatoid granulomatosis associated with Epstein-Barr virus (EBV) infection while being treated with corticosteroids and methotrexate for eosinophilic fasciitis. The woman had a history of eosinophilic fasciitis and had been on these medications for 7 years. She presented with skin lesions that had developed 2 years prior and was diagnosed with cutaneous lymphomatoid granulomatosis (grade 3) associated with EBV infection. Treatment was discontinued, and she was given prednisolone. After 9 months, her skin lesions improved and EBV DNA levels returned to normal. At a follow-up 17 months after the diagnosis, she had recovered with no evidence of involvement in other organs. [Extracted from the article]

A 14-year-old boy developed a rash while being treated with amoxicillin for an upper respiratory tract infection. He was admitted to the hospital with a fever and a widespread itchy red rash that appeared two days after starting the medication. The boy also had a sore throat, muscle pain, and fatigue. Tests revealed mildly elevated liver function and a high white blood cell count. Amoxicillin was stopped due to suspected infectious mononucleosis, and the boy was given corticosteroids and antihistamines. Serological tests confirmed an Epstein-Barr virus infection, and the boy's fever and rash eventually resolved. [Extracted from the article]

This article describes three case reports of patients who developed Epstein-Barr virus (EBV) infection and post-transplant lymphoproliferative disorder (PTLD) or experienced lack of efficacy following treatment with various drugs. The first case involved a man who developed EBV-negative PTLD after receiving tacrolimus and unspecified steroids as immunosuppressant therapy. The second case involved a woman who developed EBV-positive PTLD after receiving ciclosporin and prednisone. The third case involved a woman who developed EBV-negative PTLD and exhibited lack of efficacy to multiple treatments. These cases highlight the complexities and challenges in managing EBV infection and PTLD in transplant patients. [Extracted from the article]

He underwent the antibody test due to suspicion of the EBV infection, which revealed viral capsid antigen antibody immunoglobulin G (VCA-IgG) was 1280 fold. EBV-DNA polymerase chain reaction (PCR) revealed that the viral load increased to 2700 copies/ g DNA. [Extracted from the article]

Further examination of the lymph node histology led to a final diagnosis of Kaposi's sarcoma (KS) with a high Human Herpesvirus-8 disease viral load (and previously suspected PTLD was ruled out) attributed to tacrolimus. Bone marrow aspiration showed haemophagocytosis, and lymph node biopsy led to the diagnosis of human herpesvirus-8 disease-related Kaposi's sarcoma, Castleman's disease and plasmablastic lymphoma. Examinations showed anemia (8.4 g/dl) and thrombocytopenia (46,000/µl) and positive CMV (cytomegalovirus) viral load of 1214 copies/mL was detected, indicating CMV reactivation. [Extracted from the article]

Subsequently, the patients developed pleural effusion and pulmonary arterial hypertension secondary to dasatinib (one patient) and palpitations and chest tightness (one patient). Four out of the 5 patients received POMP regimen including oral mercaptopurine 50 mg/m SP 2 sp on days 22-28, rapid IV bolus with vincristine 2mg on day 22, oral methotrexate 20 mg/m SP 2 sp on day 1, day 8 and day 15 and oral dexamethasone 6 mg/m SP 2 sp on days 1-14. All the 5 patients had relapsed/refractory Philadelphia chromosome positive acute B-lymphoblastic leukaemia and received dasatinib along with imatinib (4 patients) and dasatinib (one patient). [Extracted from the article]

Further, serological tests found IgM positivity consistent with acute Epstein-Barr virus infection and Epstein-Barr encoding region in situ hybridisation detected Epstein-Barr virus in splenic tissue sections. Based on examinations, it was concluded that underlying Epstein-Barr virus infection resulted in splenomegaly as a result of lymphocytic infiltration and secukinumab treatment further amplified the inflammatory response leading to splenic rupture. Splenic rupture masquerading as pulmonary embolus in the context of acute Epstein-Barr virus infection and secukinumab therapy. [Extracted from the article]

The Serious Warnings and Precautions Box, Warnings and Precautions, Adverse Reactions, and Patient Medication Information sections of the Canadian product monograph for Purinethol (mercaptopurine) have been updated with the risk of macrophage activation syndrome (MAS), advises Health Canada in I Health Product Infowatch i . MAS is a life-threatening disorder that may occur in patients with autoimmune conditions, particularly in those with inflammatory bowel disease, and use of Purinethol may increase the risk of MAS, says Health Canada. Reference 1 Product monograph updates - Purinethol (mercaptopurine) Health Product InfoWatch: 27 Apr 2023. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 66-year-old woman exhibited lack of efficacy during treatment with gemcitabine, oxaliplatin and pegaspargase for chronic active Epstein-Barr virus infection (CAEBV) associated generalised myositis with extranodal NK/T-cell lymphoma [nasal type; I routes not stated i ]. Based on the findings, CAEBV associated generalised myositis infection was confirmed, and unspecified high-dose glucocorticoid with thalidomide were given. Therefore, her final diagnosis was CAEBV infection-related generalised myositis with extranodal NK/T cell lymphoma (nasal type). [Extracted from the article]

However, she developed Epstein-Barr virus infection associated with rituximab and unspecified immunosuppresants [ I duration of treatment to reaction onset not stated i ]. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 3.3-years-old girl developed Epstein-Barr virus infection and exhibited lack of efficacy during immunosuppressive therapy with rituximab and unspecified immunosuppresants [ I dosages and routes not stated i ]. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 64-year-old man developed haemophagocytic lymphohistiocytosis (HLH) with Epstein-Barr virus (EBV) infection during treatment with dabrafenib and trametinib for BRAF-mutated stage IV melanoma and hypogammaglobulinaemia during treatment with rituximab for HLH with EBV infection. The lab findings confirmed the diagnosis of HLH with EBV infection attributed to the targeted therapy. The man with BRAF-mutated stage IV melanoma, started receiving targeted therapy consisting of dabrafenib and trametinib (first-line treatment). [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 60-year-old woman exhibited a lack of efficacy during immunosuppressive treatment with cyclophosphamide, mycophenolate mofetil and tacrolimus for prevention of graft-versus-host disease. Additionally, she developed elevated serum creatinine during treatment with tacrolimus [ I not all dosages stated; routes and duration of treatment to reaction onset not stated i ]. [Extracted from the article]

Urethral stent was placed and urethroscopy biopsy confirmed monomorphic post-transplant lymphoproliferative disease epstein-barr virus positive with flow cytometry compatible with B-cell post-transplant lymphoproliferative disease. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 39-year-old woman exhibited lack of efficacy during treatment with immune-globulin and rituximab for acute antibody-mediated rejection [ I dosages and routes not stated i ]. The woman had kidney failure attributed to lupus nephritis and for which she underwent living unrelated donor kidney transplant. [Extracted from the article]

The EBV status was confirmed by next-generation sequencing, which demonstrated a presence of EBV in follicular component, but DLBCL was negative for EBV. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 58 year-old man developed Epstein-Barr virus (EBV) infection, EBV-positive follicular lymphoma (FL) and EBV-negative diffuse large B-cell lymphoma (DLBCL) during treatment with hydroxychloroquine for mixed connective tissue disease. [Extracted from the article]

During this time, EBV and CMV viraemia was not identified. The boy was diagnosed with cytomegalovirus (CMV) and EBV infection with severe hepatitis at the age of 3 months. This treatment slightly and temporarily reduced the EBV viraemia and eliminated general symptoms; however, did not cause regression of skin lesions. [Extracted from the article]

X-ray of sacroiliac joints (SIJs) revealed bilateral grade 3-4 sacroiliitis with subchondral sclerosis, partial ankyloses, obliteration of the SIJs and ankylosis in the apophyseal joints of the lumbar vertebrae. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 56-year-old man developed intestinal peripheral T-cell lymphoma following treatment with infliximab for ankylosing spondylitis (AS) [ I route not stated i ]. Abdominal and thoracic CT scan revealed a thickened walls of caecum and terminal ileum and widespread lymph node enhancements of pathological sizes in the intra-abdominal areas. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 52-year-old man developed autoimmune hepatitis (AIH) following vaccination with tozinameran for immunisation against COVID-19 [ I dosage and route not stated i ]. He was admitted and tests revealed ALT of 2130 U/L, ALP of 142 U/L, GGT of 217 U/L and bilirubin of 7.7 mg/dL indicating mixed hepatocellular/cholestatic hepatitis. Laboratory tests revealed relapse of acute mixed hepatitis with ALT of 1939 U/L, ALP of 167 U/L and bilirubin of 2.9 mg/dL. [Extracted from the article]