Case Reports

Shah, Ira

doi:10.1007/s13312-012-0077-6

Indian Pediatr

2012

DOI: 10.1007/s13312-012-0077-6

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Case Reports

Ira Shah

Abstract: Response of EBV infection to valacyclovir in HIV infected children has not been reported earlier. An 8 years old HIV infected girl with undetectable viral load and normal CD4 count on regular antiretroviral therapy presented with persistent fever, lymphadenopathy and pancytopenia due to Epstein Barr virus (EBV). The child responded to valacyclovir.

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Effects of intraocular treatments for Epstein-Barr virus (EBV) retinitis

et al. 2021

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Rationale: Intraocular infection of Epstein–Barr virus (EBV) may cause severe visual loss. However, it is relatively rare, and there is no consensus on its treatment. Patient concerns: A 44-year-old woman complained of a right-eye floater and exhibited a unilateral exudative change along the retinal veins at the Department of Ophthalmology, St. Luke's International Hospital. Diagnosis: EBV retinitis was diagnosed based on EBV-positive (9.09 × 10 3 copies/μl) and cytomegalovirus-negative results in the aqueous humor. Interventions: Oral prescription of valaciclovir hydrochloride, and an intravitreal injection of foscarnet sodium hydrate was administered. However, the retinal infiltration progressed, and vitreous opacity with cellular infiltration appeared. Intravitreal methotrexate (MTX) injection effectively suppressed retinal and vitreous infiltration. However, she developed optic-nerve papillitis, and central retinal vein occlusion related to the severe swelling of the optic-nerve, and began steroid pulse therapy. Considering the increase in intraocular EBV levels to 6.4 × 10 4 copies/ml, we restarted intravitreal foscarnet injections replacing MTX. This in turn rapidly reduced the EBV levels to 3.27 × 10 4 copies/ml, followed by papillitis alleviation. Outcomes: The intraocular MTX administration reduced the inflammatory vitreous and retinal infiltration, but not the EBV load, while foscarnet reduced the EBV load and papillitis, but not vitreous infiltration. Lessons: The retinal infiltration may have involved EBV infection to the retinal neurons but also EBV-free reactive inflammatory cells. EBV infection to the neurons may have been, at least partially, treated by intravitreal foscarnet treatment, and the reactive inflammatory cells by intravitreal MTX. Further observations are warranted to reach a consensus on treating intraocular EBV infection.

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Effects of intraocular treatments for Epstein-Barr virus (EBV) retinitis

et al. 2021

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Combining an antiviral with rituximab in EBV-related haemophagocytic lymphohistiocytosis led to rapid viral clearance; and a comprehensive review

Stefanou¹,

Tzortzi

Georgiou

et al. 2016

BMJ Case Reports

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Epstein-Barr virus (EBV)-related haemophagocytic lymphohistiocytosis (EBVr-HLH) has a better prognosis when the virus is rapidly cleared, but the best antiviral approach is controversial. We present a patient to whom the therapeutic standard rituximab was co-administered with valacyclovir and an HLH-specific treatment with favourable viral and clinical responses. We conducted an extensive literature review and contacted several world reference centres and experts to inquire about their approaches and experience. We conclude that antivirals are infrequently used for EBVr-HLH, despite their laboratory-proven and likely clinical beneficial effect on some EBV-related diseases. However, the role of antivirals remains obscure. Concerns about their lack of efficacy are based on observational data and reports of the cellular tropism of EBV. Therefore, the adjunct use of antivirals may be considered when myelotoxicity is not the primary concern, and related outcomes should be systematically recorded to produce higher quality evidence.

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Case Reports

Cited by 2 publications

References 8 publications

Effects of intraocular treatments for Epstein-Barr virus (EBV) retinitis

Effects of intraocular treatments for Epstein-Barr virus (EBV) retinitis

Combining an antiviral with rituximab in EBV-related haemophagocytic lymphohistiocytosis led to rapid viral clearance; and a comprehensive review

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