Hyperuricemia in Infectious Mononucleosis

Cowdrey, Stephen C.

doi:10.1001/jama.1966.03100170061018

Cited by 17 publications

(4 citation statements)

References 9 publications

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“…It would be reasonable to deduce that infection due to EBV may also cause oxidative stress, leading to obvious depletion of antioxidants, such as UA. In addition, three early clinical studies demonstrated a transitory UA increase during acute onset of IM, which was explained by the increase in de novo purine biosynthesis necessary to accommodate the stepped-up nucleic acid production in IM (16)(17)(18). In fact, IM patients visiting our hospital (a tertiary hospital in Tianjin Municipality with a population of ~20 million) were often cases with more severe complications, with an IM disease duration of >10-14 days.…”

Section: Discussionmentioning

confidence: 88%

“…As regards IM, the number of previous related studies is limited and the results are conflicting. A total of three early articles (16)(17)(18) with small number of recruited subjects and one previous case report (19) were retrieved. Dylewski et al (16) investigated 35 cases with IM after a case report, and reported that 7 men and 2 women had UA levels above the laboratory's upper limit of normal.…”

Section: Introductionmentioning

confidence: 99%

“…Dylewski et al (16) investigated 35 cases with IM after a case report, and reported that 7 men and 2 women had UA levels above the laboratory's upper limit of normal. Cowdrey (17) reported UA elevation during the first 10 days of the disease course in 21 patients. However, Sugita et al (19) described a case of a 27-month-old boy with persistent EBV infection and CNS manifestations, who had lymphadenopathy and low UA levels.…”

Section: Introductionmentioning

confidence: 99%

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Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women

et al. 2017

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Abstract. Infectious mononucleosis (IM) due to Epstein-Barr virus infection is common. Uric acid (UA) is an important endogenous antioxidant. To the best of our knowledge, the association between UA and IM has not been comprehensively investigated to date. The aim of the present study was to investigate this association in Chinese patients. A total of 95 patients (47 men and 48 women) with IM were recruited, along with 95 healthy controls. Clinical data were classified by patient sex. Receiver operating characteristic (ROC) curve analysis was adopted to determine the cut-off values of UA for IM diagnosis and prediction. Crude and adjusted odds ratios (ORs) of UA for IM were analyzed by binary logistic regression. The UA levels were significantly lower in IM patients compared with those in controls. In addition, UA levels in men were significantly higher compared with those in women. The ROC curve demonstrated good diagnostic and predictive values of UA for IM in both sexes. The UA cut-off values were 326.00 and 243.50 µmol/l for diagnosing IM in men and women, respectively, with a diagnostic accuracy of 76.596 and 80.208%, respectively. Binary logistic regression analysis revealed a significant risk of IM in the low UA quartiles in both sexes. Following adjustments, the ORs even increased. Women with low UA levels appeared to be more susceptible to IM. For example, the crude ORs in quartile 1 were 24.000 and 52.500 for men and women, respectively, and the respective adjusted ORs were 31.437 and 301.746 (all P<0.01). To the best of our knowledge, the present study is the first to demonstrate the inverse association between UA and IM, suggesting a progressive decrease of antioxidant reserve in IM. Moreover, low UA was suggestive of IM, particularly in women. IntroductionInfectious mononucleosis (IM) is an important clinical entity that is associated with Epstein-Barr virus (EBV) infection (1,2). This clinical manifestation was first described in 1889, but the term IM was coined in 1920, when it was discovered that a number of patients with glandular fever had similar blood films (3). In 1968, the then newly discovered EBV was identified as the cause of IM (4). The currently estimated incidence of IM is at ~500 cases per 100,000 persons annually. IM diagnosis is often established with the classical clinical triad of pharyngitis, fever and lymphadenopathy. Serological testing for the identification of EBV antibodies is required for a definitive diagnosis (1,2). The treatment of patients with IM is mainly supportive. Corticosteroids are considered as the standard treatment for severe complications associated with IM (1,2).Uric acid (UA) is a purine degradation metabolite. A high serum level of UA is considered harmful. Hyperuricemia is considered to be closely associated with a number of metabolic disorders (5-7). For example, it was previously demonstrated that UA and metabolic syndrome were closely associated, and young women with hyperuricemia were at the highest risk of developing metabolic syndrome (5). Our rece...

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women

et al. 2017

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“…Hyperuricemia appears at a high frequency in patients with infectious mononucleosis (18% -66%), however it is a finding that is often not mentioned [5] [6]. It is a transient finding, with the peak of the levels of serum uric acid occurring within the first 2 weeks of IM, which correlates best with the presence of atypical lymphocytes, a characteristic finding of IM [7]. It appears to develop more often in men than in women.…”

Section: Discussionmentioning

confidence: 99%

A Case of Infectious Mononucleosis Complicated by Severe Thrombocytopenia and Hyperuricemia

Papageorgiou

Kaltsounis

Loukidis

et al. 2016

OJBD

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Infectious mononucleosis (IM) by Epstein-Barr virus is usually a benign, self-limiting disease. Mild to moderate immune thrombocytopenia in the setting of IM is very common and appears in approximately half of these patients, however it rarely presents in severe form and troublesome haemorrhage is even rarer. Rapid spontaneous resolution is possible, with the role of steroids being controversial. Furthermore, elevation of the levels of uric acid because of immune thrombocytopenia is observed in high frequency; however this finding is usually not mentioned. It is attributed to a transient increase in purine turnover, it appears more often in men (with its peak within the first 2 weeks of IM) and it is treated with intravenous fluids and bicarbonates. The present case report describes the case of a young female patient who develops severe thrombocytopenia and intense hyperuricemia following an Epstein-Barr infection. No severe bleeding appeared, levels of uric acid normalised within the first two weeks of treatment and platelet levels rise back to normal within a month under corticosteroid therapy.

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Infectious mononucleosis prior to acute leukemia: A possible role for the epstein-barr virus

Levine

Stevens

Coccia

et al. 1972

Cancer

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Three cases of ALL preceded by IM are reported. One patient developed leukemia associated with an apparent recurrence of IM 17 months later. The other two patients, who were diagnosed as having IM one month prior to the appearance of their leukemia, had a poor response to chemotherapy and died after a brief illness. All patients had antibody to the EBV viral capsid antigen, and two had antibody to the EBV‐associated early antigen. Although IM and ALL are suspected of being caused by a virus, epidemiologic and laboratory studies indicate that the etiology of these diseases is distinct. Since IM has been well documented as a preceding event in cases of ALL as well as other lymphocytic neoplasms, it is possible that EBV may be able to activate or “switch‐on” an oncogenic process in a manner similar to that described for murine leukemia.

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Hyperuricemia in Infectious Mononucleosis

Cited by 17 publications

References 9 publications

Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women

Low uric acid level increases the risk of infectious mononucleosis and this effect is more pronounced in women

A Case of Infectious Mononucleosis Complicated by Severe Thrombocytopenia and Hyperuricemia

Infectious mononucleosis prior to acute leukemia: A possible role for the epstein-barr virus

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