# Case Report: Epstein-Barr virus-positive follicular lymphoma with high PD-L1 expression

## TL;DR

This case report describes a rare instance of EBV-positive follicular lymphoma with high PD-L1 expression and successful treatment with R-CHOP chemotherapy.

## Contribution

The novelty lies in reporting the first case of EBV-positive follicular lymphoma with high PD-L1 expression and its response to treatment.

## Key findings

- The patient showed favorable outcomes with R-CHOP chemotherapy and rituximab.
- The case highlights the potential role of EBV in PD-L1 expression in follicular lymphoma.
- It suggests immunotherapy may be a viable treatment option for similar cases.

## Abstract

Follicular lymphoma is a common B-cell lymphoma and is classified as an indolent lymphoma, more frequently seen in middle-aged and elderly individuals. In recent years, considerable research has been conducted on follicular lymphoma; however, cases of Epstein-Barr virus (EBV)-positive follicular lymphoma remain rare. Notably, follicular lymphoma with EBV positivity accompanied by high PD-L1 expression has not been reported.

We present a case of EBV-positive follicular lymphoma with high PD-L1 expression and analyze its clinicopathological features. The patient was treated with R-CHOP chemotherapy combined with the anti-CD20 antibody (rituximab), achieving favorable therapeutic outcomes. This case provides valuable insights for the pathological diagnosis and treatment of EBV-positive follicular lymphoma, as well as the role of EBV infection in PD-L1 expression. Furthermore, it raises the question of whether high PD-L1 expression suggests that immunotherapy could serve as another potential treatment strategy for EBV-positive follicular lymphoma.