Chronic active Epstein–Barr virus infection presenting as refractory chronic sinusitis

Kitamura, Wataru; Fujiwara, Hideaki; Matsumura, Akifumi; Higaki, Toru; Shibata, Rei; Toji, Tomohiro; Fujii, Soichiro; Asada, Noboru; Ennishi, Daisuke; Nishimori, Hisakazu; Fujii, Keiko; Fujii, Nobuharu; Matsuoka, Ken‐ichi; Yoshino, Tadashi; Maeda, Yoshinobu

doi:10.1007/s12185-022-03306-y

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…Literature so far has not associated acute sinusitis with EBV and alternatively sinus symptoms have rarely been documented as one of the presenting symptoms for acute infectious mononucleosis. EBV however has been related to chronic sinusitis secondary to extranodal natural killer NK/T cell lymphoma (ENKTCL) [ 8 ] . NKTCL is an aggressive malignancy commonly seen in Asian and Latin American populations and several studies have consistently associated the specified disease with EBV [ 9 ] .…”

Section: Discussionmentioning

confidence: 99%

A case of acute extensive viral sinusitis secondary to acute Epstein Barr virus

Khine,

Edupuganti,

Upadhyay

et al. 2023

European Journal of Case Reports in Internal Medicine

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Infectious mononucleosis (IM), the most common presentation of acute Epstein Barr virus (EBV) infection, typically presents with fever, pharyngitis and lymphadenopathy. We describe an unusual case of IM presenting as acute sinusitis. A 25 year-old male presented to the emergency department with worsening right frontal sinus pain along with fever, chills, and greenish nasal discharge for 3 weeks. Laboratory workup showed leukocytosis with high lymphocyte counts as well as transaminitis. Facial computerized tomography (CT) showed extensive right frontal, ethmoidal and maxillary sinusitis and antrochoanal polyp. The patient underwent endoscopy with drainage of purulent material and polyp removal. Unfortunately, cultures of the sample were not sent and bacterial infection could not be ruled out. Broad spectrum antibiotics were continued. Pathology of redundant tissue revealed large atypical lymphocytes with positive EBV-encoded RNA and lack of evidence of extranodal natural killer/T-cell (NK/T-cell) type lymphoma (ENKTCL). Tests for serum EBV IgM antibodies and EBV early Antigen antibodies were positive, indicating acute EBV infection. Lymphocytosis resolved along with significant clinical improvement at the 10-day follow up visit. Even though patient did receive antibiotics, multiple factors including isolated lymphocytosis, pathology positive for EBV with no neutrophilia were more suggestive of sinusitis caused by viral infection, EBV in this case. Lymphocytosis with fever and sore throat should prompt physicians to consider IM. There are no known reports in the literature of EBV as a causal organism for acute viral sinusitis. There are some studies relating EBV with ENKTCL. It is unknown whether this particular patient with a history of EBV sinusitis will be at high risk for nasal type lymphoma in the future. Further studies should be conducted to understand the pathogenesis and relationship between EBV and ENKTCL.

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Section: Discussionmentioning

confidence: 99%

A case of acute extensive viral sinusitis secondary to acute Epstein Barr virus

Khine,

Edupuganti,

Upadhyay

et al. 2023

European Journal of Case Reports in Internal Medicine

View full text Add to dashboard Cite

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“…It was reported that respiratory infection was the second most and most common disease caused by primary EBV infection and EBV reactivation in children, respectively [ 19 ]. Chronic EBV infection may also present with refractory chronic sinusitis [ 20 ]. EBV co-infection was also likely to occur in COVID-19 infection [ 21 ].…”

Section: Disscussionmentioning

confidence: 99%

Risk prediction for liver injury in Epstein-Barr virus infection in pediatric respiratory tract infections

Mao,

Wu,

Shi

2023

Ital J Pediatr

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Background Epstein-Barr virus (EBV) infection is likely to co-occur in pediatric respiratory tract infections (RTIs). Liver injury is the common complication of EBV infection. The detailed risk factors for liver injury in EBV infection remain elusive. We aimed to investigate the incidence, characteristics and potential risk factors for liver injury in EBV infection for early risk prediction. Methods We retrospectively recruited the pediatric RTIs cases with EBV infection according to a predefined criteria from our hospital between January 2015 and December 2017. We extracted the clinical and laboratory data from the electronical medical records. The impact of age, gender, and various parameters on the liver injury risk was investigated. Univariate logistic regression analysis was performed to analyse the association between clinical/laboratory parameters and liver injury. The related indexes were enrolled in the multivariate logistic regression analysis. Decision curve analysis was used to yield the value of related parameters in predicting liver injury. Receiver operating curve (ROC) analysis was applied to produce the C-index of white blood cell (WBC) count for liver injury. We also tested the non-linear association between WBC count and alanine aminotransferase (ALT). Results A total of 216 pediatric RTIs with EBV infection were enrolled. EBV infection is more likely to occur during the winter season. Cytomegalovirus infection was independently associated with liver injury in EBV infection (OR = 6.972, 95% CI = 1.648–29.490, p = 0.008). WBC count was independently associated with liver injury in EBV infection (OR = 1.169, 95% CI = 1.051–1.301, p = 0.004). The P interaction value between WBC count and cytomegalovirus was 0.149. The decision curve analysis showed that WBC count had larger area under curve compared with platelet (PLT) and birthweight (BW). ROC analysis yielded the c-index of WBC count: 0.75 and cut-point of 8.3. The turning point of WBC count in its association with ALT was 16.8. The p value before and after the turning point was < 0.001 and 0.123, respectively. Conclusions Cytomegalovirus co-infection demonstrated 5.972 more times of liver injury risk in EBV infection. WBC count was an independent biomarker for liver injury before the turning point of 16.8 in EBV infection. More attention should be paid to the risk of EBV infection in the winter. Cytomegalovirus infection and WBC count merit attention in the monitoring of possible liver injury in EBV infection among pediatric RTIs.

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Chronic active Epstein–Barr virus infection presenting as refractory chronic sinusitis

Cited by 2 publications

References 17 publications

A case of acute extensive viral sinusitis secondary to acute Epstein Barr virus

A case of acute extensive viral sinusitis secondary to acute Epstein Barr virus

Risk prediction for liver injury in Epstein-Barr virus infection in pediatric respiratory tract infections

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