Severe Chronic Active EBV Infection in an Adult Patient: Case Report

Ha, Sang Yoon; Chung, Chul Won; Ko, Young Hyeh

doi:10.3346/jkms.2004.19.3.453

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…There were some reports that T cells are involved in the pathology of myocarditis due to chronic EBV infection [21][22][23]. Otherwise, B cells affected by the EBV may have been scavenged by T cells [24]. Negative findings in in situ hybridization and immunohistochemistry may be attributed to the limited sensitivity.…”

Section: Discussionmentioning

confidence: 97%

Epstein–Barr virus myocarditis as a cause of sudden death: two autopsy cases

Ishikawa

Zhu

et al. 2005

Int J Legal Med

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Although the Epstein-Barr virus (EBV) causes acute infection accompanied by a high fever in young people, there appears to be few reports of a fatal outcome involving myocarditis. We report two cases of unexpected sudden death due to acute myocarditis possibly caused by the EBV. They each visited a hospital due to common cold-like symptoms and unexpectedly died several days later. In both cases, autopsy revealed myocardial necrosis with marked lymphocytic infiltration. Polymerase chain reaction (PCR) screening was positive for the EBV, whereas immunohistochemistry and in situ hybridization for the EBV were negative. Serological investigations showed a mild elevation in antiviral capsid antigen IgG and anti-EBV nuclear antigen IgG in both cases. Immunohistochemical study of lymphocytic infiltrates showed strong positivity for a T-cell marker (CD45R0) in the myocardium and pharyngeal mucosa. These cases suggest the potential risk of mortality from acute EBV infection in young people, even without severe clinical manifestations, and the importance of microbiological investigations, including PCR procedures, in postmortem diagnosis of infectious diseases.

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Section: Discussionmentioning

confidence: 97%

Epstein–Barr virus myocarditis as a cause of sudden death: two autopsy cases

Ishikawa

Zhu

et al. 2005

Int J Legal Med

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“…Cancer patients might therefore develop a lower disease incidence or severity level. There are numerous examples including childhood diseases or puberty related infection, such as EBV, where the same pathogen causes severe and sometimes life‐threatening infection in adults compared to young individuals 11–13 . Furthermore, a number of studies have characterized how previously acquired non‐protective immunity increases disease severity in a subsequent infection 14 .…”

Section: Discussionmentioning

confidence: 99%

SARS‐CoV‐2 infections in cancer outpatients—Most infected patients are asymptomatic carriers without impact on chemotherapy

et al. 2020

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Oncologic patients are regarded as the population most at risk of developing a severe course of COVID‐19 due to the fact that malignant diseases and chemotherapy often weaken the immune system. In the face of the ongoing SARS‐CoV‐2 pandemic, how particular patients deal with this infection remains an important question. In the period between the 15 and 26 April 2020, a total of 1227 patients were tested in one of seven oncologic outpatient clinics for SARS‐CoV‐2, regardless of symptoms, employing RT‐qPCR. Of 1227 patients, 78 (6.4%) were tested positive of SARS‐CoV‐2. Only one of the patients who tested positive developed a severe form of COVID‐19 with pneumonia (CURB‐65 score of 2), and two patients showed mild symptoms. Fourteen of 75 asymptomatic but positively tested patients received chemotherapy or chemo‐immunotherapy according to their regular therapy algorithm (±4 weeks of SARS‐CoV‐2 test), and 48 of 78 (61.5%) positive‐tested patients received glucocorticoids as co‐medication. None of the asymptomatic infected patients showed unexpected complications due to the SARS‐CoV‐2 infection during the cancer treatment. These data clearly contrast the view that patients with an oncologic disease are particularly vulnerable to SARS‐CoV‐2 and suggest that compromising therapies could be continued or started despite the ongoing pandemic. Moreover the relatively low appearance of symptoms due to COVID‐19 among patients on chemotherapy and other immunosuppressive co‐medication like glucocorticoids indicate that suppressing the response capacity of the immune system reduces disease severity.

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“…CAEBV typically develops in younger patients after an initial EBV infection, but cases in older individuals are sometimes reported 219,223,224,227 . The diagnosis of such cases relies on the presence of the EBV genome in peripheral blood as detected by PCR.…”

Section: Relationship To Chronic Active Ebv Infectionmentioning

confidence: 99%

Leukemia and Lymphoma of Natural Killer Cells

Suzuki

2005

J Clin Exp Hematopathol

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Malignant hematolymphoid disorders arising from NK cells have become widely recognized over the past decade. The two forms of NK-cell malignancy, aggressive NK-cell leukemia (ANKL) and extranodal NK-cell lymphoma of nasal type (ENKL) are both characterized by the proliferation of tumor cells with an NK-cell like immunophenotype. ANKL usually presents with bone marrow tumor cells accompanied by circulating leukemic cells, and hepatosplenomegalay is a common clinical feature. ENKL most frequently affects the nasal or paranasal regions, with cutaneous involvement also being common. Approximately 70 percent of ENKL present with localized tumor cells, and follow an indolent clinical course, but, in advanced cases, tumors rapidly expand and are frequently fatal. Tumor cells from both ANKL and ENKL are surface CD3 − and CD56 + but differ in their expression of CD16. Epstein-Barr virus (EBV) is found in most cases of NK-cell leukemia/lymphoma, suggesting an oncogenic role, but patients may have biclonal or polyclonal populations of malignant cells based on differential EBV genome incorporation. NK-cell neoplasms are frequently resistant to chemotherapy due to p-glycoprotein expression and associated multidrug resistance. The prognoses of both localized and advanced stages of NK-cell malignancies are worse than most other lymphoid malignancies, but studies are currently underway to assess the safety and efficacy of novel chemoradiotherapy regimens for the treatment of these neoplasms.

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Severe Chronic Active EBV Infection in an Adult Patient: Case Report

Cited by 7 publications

References 13 publications

Epstein–Barr virus myocarditis as a cause of sudden death: two autopsy cases

Epstein–Barr virus myocarditis as a cause of sudden death: two autopsy cases

SARS‐CoV‐2 infections in cancer outpatients—Most infected patients are asymptomatic carriers without impact on chemotherapy

Leukemia and Lymphoma of Natural Killer Cells

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