Case Presentation:
34 yr old female with no past medical and surgical history was admitted with 4 days of vomiting, fever and shortness of breath. On examination, she was febrile and icteric.Lung exam revealed bibasilar dullness to percussion but no added sounds.Heart sounds were muffled. The rest of the exam was unremarkable. Lab results showed normal blood counts, bilirubin of 2.6 mg%, elevated transaminase and negative hepatitis panel. Chest and Abdominal CT showed pericardial effusion, bilateral pleural effusions and pelvis ascites(Image 1).Her symptoms resolved with supportive care.Viral serologies showed IgM and IgG positive for EBV.Antibody to EBV nuclear antigen (anti‐EBNA) was positive as well, confirming acute Epstein‐Barr virus infection. She was discharged home on day 5 and at one week follow up visit,her liver functions had normalized with completes resolution of polyserosites.
Discussion:
To our knowledge, this is the first reported case of acute EBV infection presenting as jaundice and polyserosites. (1) Epstein‐Barr virus is a member of Herpesvirus family.(2)Infection spreads by contact with oral secretions(3) but sexual transmission has also been suggested(3). EBV has been associated with Infectious Mononucleosis (IM), Burkitt's lymphoma and nasopharyngeal carcinoma. IM is a clinical triad of fever, sore throat, and lymphadenopathy.Headaches, myalgia, nausea, chills, arthralgia,jaundice and hepato‐splenomegaly can also occure.(4).Lab findings include leukocytosis with atypical T‐lymphocytes, heterophile antibodies, elevated transaminase , IgM antibodies and Anti‐EBNA antibodies. Complications are rare,and include Hepatitis,Hepatic necrosis, Pericarditis, Myocarditis, Glomerulonephritis, Interstitial nephritis,Pneumonian and Interstitial pneumonitis(5).Treatment is supportive with reassurance in uncomplicated cases.
References:
Ovid, PubMed and MedLine search
Manual of Clinical Microbiology. Patrick R, Lennette et el. 6th edition ASM.1995;905‐10
Andreoli, Carpanter, Loscalzo. Cecil Essentials of Medicine 6th Edition,2004: 829‐33
Jeffrey I. Cohen. Epstein ‐ Barr virus Infection. NEJM 2000:343: 481‐92
Stephen E. Straus, Jeffrey I, Tosato,Jeffery Meier. Epstein‐Barr Virus Infections: Biology, Pathogenesis, and Management: Ann of Int Med,1993:18;45‐57
Author Disclosure Block:
I. Nawaz, None; T.M. Mahmoudi, None; H. Ostman, None; E. Deppert, None.