Korean J Gastroenterol.  2016 Jan;67(1):39-43. 10.4166/kjg.2016.67.1.39.

A Case of Severe Chronic Active Epstein-Barr Virus Infection with Aplastic Anemia and Hepatitis

• Lee JI
• Lee SW
• Han NI
• Ro SM
• Noh YS
• Jang JW
• Bae SH
• Choi JY
• Yoon SK

• KMID: 2373392
• DOI: http://doi.org/10.4166/kjg.2016.67.1.39

Abstract

Epstein-Barr virus (EBV) causes various acute and chronic diseases. Chronic active EBV infection (CAEBV) is characterized by infectious mononucleosis-like symptoms that persist for more than 6 months with high viral loads in peripheral blood and/or an unusual pattern of anti-EBV antibodies. Severe CAEBV is associated with poor prognosis with severe symptoms, an extremely high EBV-related antibody titer, and hematologic complications that often include hemophagocytic lymphohistiocytosis. However, CAEBV which led to the development of aplastic anemia (AA) has not been reported yet. A 73-year-old woman was admitted to our hospital with intermittent fever, general weakness and elevated liver enzymes. In the serologic test, EBV-related antibody titer was elevated, and real-time quantitative-PCR in peripheral blood showed viral loads exceeding 10(4) copies/microg DNA. Liver biopsy showed characteristic histopathological changes of EBV hepatitis and in situ hybridization with EBV-encoded RNA-1 was positive for EBV. Pancytopenia was detected in peripheral blood, and the bone marrow aspiration biopsy showed hypocellularity with replacement by adipocytes. AA progressed and the patient was treated with prednisolone but deceased 8 months after the diagnosis due to multiple organ failure and opportunistic infection. Herein, we report a rare case of severe CAEBV in an adult patient accompanied by AA and persistent hepatitis.

Keyword

Epstein-Barr virus infections; Human herpesvirus 4; Hepatitis; Aplastic anemia

MeSH Terms

Aged
Anemia, Aplastic/*complications
Carbapenems/therapeutic use
Chronic Disease
DNA, Viral/blood
Epstein-Barr Virus Infections/complications/*diagnosis/pathology
Female
Hepatitis/*complications
Herpesvirus 4, Human/*genetics/isolation & purification
Humans
Real-Time Polymerase Chain Reaction
Severity of Illness Index
Urinary Tract Infections/drug therapy
Carbapenems
DNA, Viral