J Korean Ophthalmol Soc.  2014 Oct;55(10):1554-1557. 10.3341/jkos.2014.55.10.1554.

A Case of Conjunctival Mass with Infectious Mononucleosis by EBV

• Shin KY
• Chang MH
• Kyung SE

• KMID: 2216878
• DOI: http://doi.org/10.3341/jkos.2014.55.10.1554

Abstract

PURPOSE
To report a case of conjunctival mass with infectious mononucleosis by Epstein-Barr virus (EBV) confirmed with Epstein-Barr encoding region (EBER) in situ hybridization.
CASE SUMMARY
A 8 year-old male without underlying disease was referred with counjunctival mass on the right eye starting 3 days ago. In ophthalmologic evaluation, there was injected, nontender, and "salmon patch" appearance conjunctival lesion on right superior bulbar conjunctiva. The patient was admitted to pediatrics with sore throat and fever. The tonsil were enlarged and white blood cell count was 14960/uL. EBV polymerase chain reaction (PCR) test and Viral capsid antigen Immunoglobulin M (VAC IgM) test were positive, the diagnose of infectious mononucleosis by EBV was made. After 5 days steroid eyedrop therapy, biopsy was performed because the lesion was not improved. There were lymphocyte infiltration, chronic inflammation and positive in EBER in situ hybridization.
CONCLUSIONS
Elevated and pinkish lesion on conjunctiva, EBV lesion should be considered as differential diagnosis.

Keyword

Conjunctival mass; Infectious mononucleosis

MeSH Terms

Biopsy
Capsid
Conjunctiva
Diagnosis, Differential
Fever
Herpesvirus 4, Human*
Humans
Immunoglobulin M
In Situ Hybridization
Infectious Mononucleosis*
Inflammation
Leukocyte Count
Lymphocytes
Male
Palatine Tonsil
Pediatrics
Pharyngitis
Polymerase Chain Reaction
Immunoglobulin M

Figure

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  Figure 1. (A, B) The slit lamp examination showed “Salmon patch” lesion on suprabulbar conjunctiva of the right eye at the first visit. (C) At 2 months later, suprabulbar injected lesion was improved, (D) at 6 months later, suprabulbar lesion returned to normal.

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  Figure 2. Serum Epstein-Barr virus (EBV) polymerase chain reaction (PCR). (A) Patient, (B) positive sample. (C) Negative sample.

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  Figure 3. (A) Microscopically, the biopsy specimen of conjunctival mass reveals a dense lymphoplasm a cell infiltrate in lamina propria as well as into epithelium (hematoxylin-eosin stain, original magnification ×400). (B) Epstein-Barr virus is detected in some lymphocytes by Epstein-Barr encoding region (EBER) in situ hybridization (in situ hybridization, original magnification ×400).

Reference

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