Monkeypox virus: A new etiology for reactive lymphocytes in peripheral blood

[摘要] A 32-year-old male with a history of well-controlled HIV infection(with a normal CD4(+) T-cell count [501 × 106/L; reference range495–1635 × 106/L]) presented with acute new-onset skin lesions(scattered umbilicated papules near mouth and base of bilateralgroin area), sore throat, fever, myalgias, and tonsillar/genital ulcerations, with known recent exposure to monkeypox virus. Infectiousevaluation demonstrated monkeypox virus (West African clade, byPCR from genital lesion), HSV1 (by PCR) and Streptococcus dysgalactiae (from throat sample); SARS-CoV-2 and HSV2 were negative byPCR, as was Epstein-Barr virus by monospot. Review of peripheralblood (PB) smear demonstrated a normal lymphocyte count (3.55 ×109/L) with scattered highly pleomorphic reactive lymphocytes,from immunoblasts with large nuclei, distinct nucleoli, and abundant basophilic cytoplasm (Figure 1A–C) to lymphoplasmacytoidlymphocytes and plasmacytic cells with eccentric nuclei containingcondensed chromatin (Figure 1D–F).

[关键词] Monkeypox virus;reactive lymphocytes