Pediatr Gastroenterol Hepatol Nutr.  2018 Apr;21(2):147-153. 10.5223/pghn.2018.21.2.147.

Acute Gastritis and Splenic Infarction Caused by Epstein-Barr Virus

• Jeong JE
• Kim KM
• Jung HL
• Shim JW
• Kim DS
• Shim JY
• Park MS
• Park SK

• KMID: 2409367
• DOI: http://doi.org/10.5223/pghn.2018.21.2.147

Abstract

Epstein-Barr virus (EBV) infection can be presented with various clinical manifestations and different levels of severity when infected. Infectious mononucleosis, which is most commonly caused by EBV infection in children and adolescents, is a clinical syndrome characterized by fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. But rarely, patients with infectious mononucleosis may present with gastrointestinal symptoms and complicated by gastritis, splenic infarction, and splenic rupture. We encountered a 16-year-old girl who presented with fever, fatigue, and epigastric pain. Splenic infarction and EBV-associated gastritis were diagnosed by using esophagogastroduodenoscopy and abdominal computed tomography. Endoscopy revealed a generalized hyperemic nodular lesion in the stomach, and the biopsy findings were chronic gastritis with erosion and positive in situ hybridization for EBV. As splenic infarction and acute gastritis are rare in infectious mononucleosis and are prone to be overlooked, we must consider these complications when an infectious mononucleosis patient presents with gastrointestinal symptom.

Keyword

Herpesvirus 4; human; Gastritis; Splenic infarction; Infectious mononucleosis

MeSH Terms

Adolescent
Biopsy
Child
Endoscopy
Endoscopy, Digestive System
Epstein-Barr Virus Infections
Fatigue
Female
Fever
Gastritis*
Herpesvirus 4, Human*
Humans
In Situ Hybridization
Infectious Mononucleosis
Lymphatic Diseases
Pharyngitis
Splenic Infarction*
Splenic Rupture
Stomach

Figure

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  Fig. 1 Abdominal and pelvis computed tomography (CT) showed (A) hepatosplenomegaly and 2×1.6 cm, sized low attenuated lesion (white arrow), which that was consistent with splenic infarction; and (B) multiple slightly enlarged lymph nodes around aorta and mesentery (white arrows). Follow-up abdominal ultrasonography on the fifth hospital day showed (C) no sonographic evidence of splenic infarction or other focal lesion of the spleen.

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  Fig. 2 Characteristics of the patient's esophagogastroduodenoscopy (EGD) image Endoscopic image showing (A) hyperemic nodular lesion (asterisk) and (B) linear erosions (arrows). Five months after discharge, follow up EGD revealed (C, D) linear red streak detected on the body large curvature side (arrows).

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  Fig. 3 Microscopic findings. (A) There is diffuse atypical lymphocytes proliferation in the lamina propria (H&E, ×200). (B) It shows positive for Epstein-Barr virus-encoded DNA staining (in situ hybridization method, ×200).

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