A rare case of acute pancreatitis and life-threatening hemolytic anemia associated with Epstein–Barr virus infection in a young healthy adult

Singh, Sukhchain; Khosla, Pam

doi:10.1016/j.jiph.2015.06.011

Cited by 8 publications

(3 citation statements)

References 11 publications

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“…A review of the English literature was performed: a PubMed search, using as keywords acute pancreatitis AND (EBV OR Epstein-Barr virus), revealed only 10 pediatric [8,[10][11][12][13][14][15][16][17][18] and 6 adult cases [9,[19][20][21][22][23]. As regards pediatric reports (Table I), median age and mean age was 12 and 11.8 years respectively (range 3-18), 36% were male and 64% were female.…”

Section: Discussionmentioning

confidence: 99%

Epstein-Barr virus-associated acute pancreatitis: a clinical report and review of literature

et al. 2022

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Background Acute pancreatitis is a disorder of reversible inflammation of the pancreas. Only a few cases are related to infections and the most common pathogens are the viruses responsible for mumps, parotitis, and influenza. Epstein-Barr virus (EBV)-associated acute pancreatitis is a rare condition and it may occur in children and adults. Case presentation A 3-year-old female was admitted to the “G. Di Cristina” Children's Hospital in Palermo for vomiting and abdominal pain. Laboratory investigations revealed elevated amylase and lipase, with normal liver function tests. Abdominal ultrasound demonstrated an enlarged pancreas, with hypoechogenic areas; no biliary lithiasis was observed. Infectious disease serology was positive for the presence of EBV VCA IgM and IgG. A diagnosis of EBV-associated acute pancreatitis was made. The patient was treated conservatively and recovered. Conclusions Acute pancreatitis is rarely associated with EBV infection; a review of the English literature revealed only 10 pediatric and 6 adult cases. Patients with pancreatitis should always be evaluated for EBV serology, even in the absence of the typical clinical and hematological features of infectious mononucleosis. For these patients, good prognosis is generally expected.

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Section: Discussionmentioning

confidence: 99%

Epstein-Barr virus-associated acute pancreatitis: a clinical report and review of literature

et al. 2022

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“…All of these symptoms were noted in the ambulatory care visits but were downplayed or lost completely when Julia was admitted to the hospital; the inpatient diagnostic efforts were re-directed to understand her cholestasis and direct hyperbilirubinemia. Acalculous cholecystitis is a rare presentation of Epstein-Barr infection, and though now well documented in the medical literature [7][8][9][10][11][12][13][14], was not considered by any of the clinicians ante-mortem. Further, the initial reading of the ultrasound mentioned that the gallbladder abnormalities could have been secondary to another, possibly hepatic process.…”

Section: Discussionmentioning

confidence: 99%

Learning from tragedy: the Julia Berg story

et al. 2018

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This is a case report involving diagnostic errors that resulted in the death of a 15-year-old girl, and commentaries on the case from her parents and involved providers. Julia Berg presented with fatigue, fevers, sore throat and right sided flank pain. Based on a computed tomography (CT) scan that identified an abnormal-appearing gall bladder, and markedly elevated bilirubin and “liver function tests”, she was hospitalized and ultimately underwent surgery for suspected cholecystitis and/or cholangitis. Julia died of unexplained post-operative complications. Her autopsy, and additional testing, suggested that the correct diagnosis was Epstein-Barr virus infection with acalculous cholecystitis. The correct diagnosis might have been considered had more attention been paid to her presenting symptoms, and a striking degree of lymphocytosis that was repeatedly demonstrated. The case illustrates how cognitive “biases” can contribute to harm from diagnostic error. The case has profoundly impacted the involved healthcare organization, and Julia’s parents have become leaders in helping advance awareness and education about diagnostic error and its prevention.

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“…Most patients with primary EBV infections improve without permanent consequences. EBV infections can lead to hematologic symptoms such as thrombocytopenia, neutropenia, hemolytic anemia, and lymphocytosis [5,6]. Platelets have an important role in inflammatory reactions.…”

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Evaluation of Platelet Parameters in Children with Primary Epstein-Barr Virus Infection

Almis¹,

Bucak²,

Turğut³

2017

Ann Clin Anal Med

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Epstein-Barr virüs (EBV) herpes virüs ailesindendir. Çocuklarda yaşam boyu süren enfeksiyonlara ve birkaç kanser tipinin gelişmesinde rol oynamaktadır. Primer enfeksiyonu asemptomatik veya nonspesifik hafif bulgularla seyreder. Bu çalışmamızdaki amacımız primer EBV enfeksiyonlu hastalarda inflamatuvar sürecin trombosit parametrelerini, trombosit lenfosit oranını (TLO) ve nötrofil lenfosit oranını (NLO) etkileyip etkilemediğinin ortaya konulmasıdır. Gereç ve Yöntem: Çalışmamız retrospektif bir çalışma olup çalışmamıza 44 primer EBV enfeksiyonlu hasta ile 66 sağlıklı hasta dahil edildi. Her iki grubun demografik verileri ile laboratuvar bulguları kayıt edildi. Verilerin istatistiksel analizinde SPSS 22.0 programı kullanıldı. Niteliksel ve niceliksel verilerin analizinde Student's t-testi, Mann-Whitney U testi, ki kare testleri kullanıldı. İstatistiksel olarak anlamlılık için p < 0,05 değeri alındı. Bulgular: Ortalama trombosit sayısı, ortalama trombosit hacmi, albümin düzeyleri ve trombosit lenfosit oranı çalışma grubunda kontrol grubuna kıyasla anlamlı düzeyde düşük saptandı (p değerleri sırasıyla 0.028, 0.002, 0.012 ve <0.001'idi). Ortalama ürik asit düzeyi ile trombosit dağılım genişliği düzeyi ise çalışma grubunda kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek saptandı (p değerleri sırasıyla 0.007 ve <0.001 idi). Trombosit dağılım genişliği için 13,7 optimal cutoff düzeyi olarak alındığında [eğri altında kalan alan: 0,774] olup bu değer primer EBV enfeksiyonu için % 81 özgüllüğe, % 79,5 duyarlılığa sahipti (p< 0,001). Tartışma: Çalışmamız primer EBV enfeksiyonunun trombosit sayısı ve trombosit göstergelerini etkilediğini göstermesi açısından oldukça anlamlıdır. Trombosit parametrelerinin etkilendiği enfeksiyonlarda EBV, ilk düşünülmesi gereken viral etkenlerden biri olmalıdır. Trombosit göstergelerinin EBV enfeksiyonunda oynadığı rolü açıklayacak prospektif çalışmalara ihtiyaç vardır.

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A rare case of acute pancreatitis and life-threatening hemolytic anemia associated with Epstein–Barr virus infection in a young healthy adult

Cited by 8 publications

References 11 publications

Epstein-Barr virus-associated acute pancreatitis: a clinical report and review of literature

Epstein-Barr virus-associated acute pancreatitis: a clinical report and review of literature

Learning from tragedy: the Julia Berg story

Evaluation of Platelet Parameters in Children with Primary Epstein-Barr Virus Infection

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