Recurrent hepatosplenomegaly and peripheral blood cytopenia, persistent Epstein‐Barr virus infection and central nervous system manifestation in a patient with lymphadenopathy and low serum uric acid

Sugita, Kenichi; Hagisawa, Susumu; Satoh, Yuhya; Eguchi, Mitsuoki; Furukawa, Toshiharu

doi:10.1111/j.1442-200x.1998.tb01949.x

Cited by 6 publications

(7 citation statements)

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“…These symptoms may even be typical of patients with EBV reactivation, as cognitive impairment, emotional instability, tiredness, dysarthria, and chorea were also observed among the 10 previously published patients with CNS disease due to EBV reactivation [Leavell et al, 1986;Tolly et al, 1989;Walter et al, 1989;Dagan and Shahak, 1993;Imai et al, 1993;Tachi et al, 1993;Morita and Tsuge, 1998;Sugita et al, 1998]. As in our patients, the laboratory findings of the cases reported were divergent, showing high anti-EA antibody titres in 6, positive blood PCR in 4, CSF or brain tissue PCR in 3, and AI in 3 cases.…”

Section: Discussionmentioning

confidence: 90%

“…Therefore, a search for acute primary EBV infections is well established in patients with central nervous system (CNS) diseases [Copperman, 1977;Weinstein, 1991;Cohen, 2000]. In contrast, neurological disease complicating the course of chronic active EBV infections [Shoji et al, 1992;Morita and Tsuge, 1998] or occurring in immunocompetent paediatric patients with reactivated EBV infections has been described only rarely [Leavell et al, 1986;Tolly et al, 1989;Walter et al, 1989;Dagan and Shahak, 1993;Imai et al, 1993;Tachi et al, 1993;Morita and Tsuge, 1998;Sugita et al, 1998]. …”

Section: Introductionmentioning

confidence: 99%

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Neurological complications of acute and persistent Epstein‐Barr virus infection in paediatric patients

Häusler

Ramaekers

Doenges

et al. 2002

Journal of Medical Virology

108

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Neurological complications of Epstein-Barr virus (EBV) have been reported almost exclusively in the course of acute primary infections. The role of EBV in paediatric neurological disease was investigated prospectively over a 2-year period, searching for acute primary, chronic, and reactivated EBV infections. Active EBV infections were diagnosed in 10/48 patients, including two with acute primary EBV infections (cranial neuritis and cerebellitis), one with chronic active infection (T/NK cell lymphoma with cranial neuritis), and seven with reactivated infections. Among these seven patients, three showed "Alice in Wonderland" syndrome, one facial nerve palsy, one progressive macrocephaly, and two prolonged encephalitic illness. The prognosis was good except for the patient with lethal T/NK cell lymphoma and the two girls with encephalitic illness. Despite steroid treatment, these girls suffered prolonged cognitive impairment and epileptic seizures. Both developed left-sided hippocampal atrophy, and one of them hippocampal sclerosis. Like primary infections, reactivated EBV infections cause neurological complications in a considerable number of paediatric patients, lead to serious long-term complications, and may contribute to the pathogenesis of hippocampal lesions.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Neurological complications of acute and persistent Epstein‐Barr virus infection in paediatric patients

Häusler

Ramaekers

Doenges

et al. 2002

Journal of Medical Virology

108

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“…Autoimmune neutropenia may present in previously healthy individuals (primary or idiopathic) or in patients with an underlying disease (secondary). It is mainly diagnosed in infancy and has been associated with viruses, such as Epstein-Barr virus and parvovirus B19 (25,26). In our study, an associated infectious agent (influenza B) was only identified in one case with autoimmune neutropenia.…”

Section: Discussionmentioning

confidence: 50%

The epidemiology, clinical course and outcome of febrile cytopenia in children

et al. 2015

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“…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%

“…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. LI ZHANG 1* , PINGPING ZHOU 2* , ZHAOWEI MENG 2 , LU GONG 1 , CHONGJIE PANG 1 , XUE LI 2 , QIANG JIA 2 , JIAN TAN 2 , NA LIU 2 , TIANPENG HU 2 , QING ZHANG 3 , QIYU JIA 3 and KUN SONG 3 Departments of 1 Therefore, the aim of the present study was to analyze the associations between UA and IM in a comprehensive manner, in order to determine whether low UA is a significant risk factor for IM, and whether there is a sex difference.…”

Section: Introductionmentioning

confidence: 99%

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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Recurrent hepatosplenomegaly and peripheral blood cytopenia, persistent Epstein‐Barr virus infection and central nervous system manifestation in a patient with lymphadenopathy and low serum uric acid

Abstract: Key wordsKENICHI SUGITA, SUSUMU HAGISAWA, YUHYA SATOH, MITSUOKl EGUCHI AND TOSHIHARU FURUKAWA

Cited by 6 publications

References 11 publications

Neurological complications of acute and persistent Epstein‐Barr virus infection in paediatric patients

Neurological complications of acute and persistent Epstein‐Barr virus infection in paediatric patients

The epidemiology, clinical course and outcome of febrile cytopenia in children

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

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