Acute Renal Failure in a Child With Thrombocytopenic Purpura Caused by Acute Epstein-Barr Virus Infection After Treatment With Anti–D Immunoglobulin

Kossiva, Lydia; Kyriakou, Dimitrios; Mitsioni, Andromachi; Garoufi, Anastasia

doi:10.1097/pec.0b013e318294f3a5

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…Neurological complications were not rare, including direct viral damage and secondary immunity damage with diverse and nonspecific manifestations and good prognosis 26 . In addition, EBV infection can cause rare complications of hematological, 27 cardiovascular, 28 and genitourinary 29 systems. EBVRI was prone to multi‐systemic damage.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of primary and reactivated Epstein‐Barr virus infection in children

Yang

Gao

2020

Journal of Medical Virology

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Epstein‐Barr virus (EBV) infection occurs commonly in children and presents as a primary or reactivated infection, which are difficult for clinicians to distinguish. This study investigated the clinical characteristics of the two types of infections. Children with detectable plasma EBV‐DNA were retrospectively enrolled and divided into primary and reactivated infection group by EBV‐specific antibody. We analyzed the patients' characteristics, clinical manifestations, complications, inflammatory biomarkers, and viral load. A total of 9.3% of children with reactivation were immunocompromised over the long‐term. The primary infection mostly appeared as infectious mononucleosis (99.8%), while reactivation occurred as an infectious mononucleosis‐like disease (65.0%), hemophagocytic syndrome (22.6%), chronic active EBV infection (5.3%) and lymphoma (3.5%). The incidence of fevers, cervical lymphoditis, periorbital edema, pharyngotonsillitis, hepatomegaly and splenomegaly in primary infection were 93.3%, 93.0%, 51.5%, 66.0%, 76.2% and 63.9%, respectively; the incidence of those symptoms in reactivation was 84.0%, 46.9%, 15.4%, 18.5%, 18.5%, and 43.3%, respectively. The incidence of digestive, respiratory, cardiovascular, neurological, hematological, genitourinary complications and multiple serous effusion in primary infection was 68.8%, 18.1%, 8.0%, 0.8%, 2.9%, 0.0% and 2.3%; whereas the incidence of these complications in reactivation was 56.2%, 22.5%, 14.1%, 8.0%, 38.9%, 0.3% and 19.0%. Patients with reactivation were more prone to multi‐systemic damage. B‐cells were lower, and CD8+ T‐cells were higher in primary infection. Viral load was correlated with the level of different cytokines in primary and reactivated infection. EBV primary infection often presents as infectious mononucleosis. The reactivated infection affects more immunocompromised subjects with diverse and complex manifestations. Various complications are more commonly associated with reactivation as a result of different inflammatory responses to different types of infection.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics of primary and reactivated Epstein‐Barr virus infection in children

Yang

Gao

2020

Journal of Medical Virology

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“…A number of previous studies documented the role of EBV in induction of thrombocytopenia. While the presence of EBV in patients with infectious mononucleosis is usually associated with a slight decrease in platelet count, in the case of CAEBV, it can be associated with severe thrombocytopenia, anemia (usually of autoimmune origin), and splenomegaly (resulting from lymphocyte infiltration) or even liver failure [ 14 , 15 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

High Viral Loads of Epstein-Barr Virus DNA in Peripheral Blood of Patients with Chronic Lymphocytic Leukemia Associated with Unfavorable Prognosis

et al. 2015

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Epstein-Barr virus (EBV) is a ubiquitous γ-herpesvirus that infects more than 90% of the world population. The potential involvement of EBV in the clinical course of chronic lymphocytic leukemia (CLL) remains unexplained. The aim of this study was to determine whether EBV-DNA load in the peripheral blood mononuclear cells (PBMCs) of CLL patients may influence heterogeneity in the course of the disease. The study included peripheral blood samples from 115 previously untreated patients with CLL (54 women and 61 men) and 40 healthy controls (16 women and 24 men). We analyzed the association between the EBV-DNA load in PBMCs and the stage of the disease, adverse prognostic factors, and clinical outcome. Detectable numbers of EBV-DNA copies in PBMCs were found in 62 out of 115 CLL patients (53.91%). The EBV-DNA copy number/μg DNA was significantly higher in patients who required early implementation of treatment, presented with lymphocyte count doubling time <12 months, displayed CD38-positive or ZAP-70-positive phenotype, and with the del(11q22.3) cytogenetic abnormality. Furthermore, the EBV-DNA copy number/μg DNA showed significant positive correlation with the concentrations of lactate dehydrogenase (LDH) and beta-2-microglobulin. We have shown that in CLL patients, higher EBV-DNA copy number predicted shorter survival and shorter time to disease progression, and it was associated with other established unfavorable prognostic factors. This suggests that EBV may negatively affect the outcome of CLL.

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“…The primary form of IT, classically defined “idiopathic,” is often seen in childhood and triggered by non-specific viral infections (upper respiratory or gastrointestinal infections): in some cases acute infections by Epstein–Barr virus, cytomegalovirus, parvovirus, rubella, mumps, and varicella have been identified as triggers of ITP ( 10 – 12 ).…”

Section: Etiology Of Itpmentioning

confidence: 99%

The Centenary of Immune Thrombocytopenia—Part 2: Revising Diagnostic and Therapeutic Approach

2017

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Primary immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in children and adolescents and can be considered as a paradigmatic model of autoimmune disease. This second part of our review describes the clinical presentation of ITP, the diagnostic approach and overviews the current therapeutic strategies. Interestingly, it suggests an algorithm useful for differential diagnosis, a crucial process to exclude secondary forms of immune thrombocytopenia (IT) and non-immune thrombocytopenia (non-IT), which require a different therapeutic management. Advances in understanding the pathogenesis led to new therapeutic targets, as thrombopoietin receptor agonists, whose role in treatment of ITP will be discussed in this work.

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Acute Renal Failure in a Child With Thrombocytopenic Purpura Caused by Acute Epstein-Barr Virus Infection After Treatment With Anti–D Immunoglobulin

Cited by 9 publications

References 18 publications

Clinical characteristics of primary and reactivated Epstein‐Barr virus infection in children

Clinical characteristics of primary and reactivated Epstein‐Barr virus infection in children

High Viral Loads of Epstein-Barr Virus DNA in Peripheral Blood of Patients with Chronic Lymphocytic Leukemia Associated with Unfavorable Prognosis

The Centenary of Immune Thrombocytopenia—Part 2: Revising Diagnostic and Therapeutic Approach

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