Case report: a diagnostically challenging conjunctival mass caused by the Epstein-Barr virus

Abstract

We present a paediatric case of infectious mononucleosis in a 13-year old, manifesting with follicular conjunctivitis and a conjunctival mass in one eye with no evidence of leucocytosis on the blood count. The diagnosis was confirmed following surgical excision and biopsy. The case represented a diagnostic challenge due to its atypism and given the steady increase in the prevalence of EBV-related ocular diseases in the last years, this report can serve as an example to prompt earlier serological tests to identify the aetiology in similar cases. This is important because EBV can be treated with acyclovir early in the active viral phase.

Anterior segment involvement in Epstein–Barr virus: a review

“…2009; Chervenkoff et al. 2015; Vaivanijkul 2017). All these masses were biopsied, finding lymphocytic cells without atypia, histiocytes and plasma cells.…”

“…Vaivanijkul, (2017) stated that in doubtful cases, such as fast-growing or wide-spread masses in patients with systemic mononucleosis and compatible serology, a conjunctival biopsy may be necessary to rule out malignancy. In addition, age seems to be a determining factor, since most cases of salmoncoloured conjunctival masses in young patients are EBV-positive Reactive Hyperplasia (Chervenkoff et al 2015). However, in elderly patients (above 60 years old), the differential diagnosis with lymphoma should be highly considered (Type et al 2015).…”

Eyelid edema as a rare manifestation of infectious mononucleosis

“…The diagnosis of infectious mononucleosis is based on the presenting signs and symptoms, and laboratory blood test results [4]. The blood count very commonly shows leukocytosis with a highly differentiated lymphocyte count along with the presence of atypical enlarged lymphocytes, which represents a characteristic feature of the disease [8]. Immunological findings include the detection of non-specific heterophilic antibodies in the Paul-Bunnell-Davidsohn reaction or specific antibodies against the Epstein-Barr (EBV) virus using more advanced assay techniques [4].…”

“…findings characteristic of infectious mononucleosis, but with no typical leukocytosis. However, a case of mononucleosis infection in a pediatric patient with conjunctival involvement but without accompanying leukocytosis has already been reported in the literature [8]. Another diagnostic difficulty is the age of the patient.…”

Masa conjuntival como primera manifestación de infección por virus del Epstein Barr

“…En nuestro caso se evidenció como primera manifestación de la infección del VEB una masa conjuntival superior, unilateral, de rápido crecimiento asociado a adenopatías cervicales e inguinales y esplenomegalia sin otra sintomatología ocular o sistémica simultánea. En los pocos reportes de casos descritos, estas masas tienen las características de ser color salmón o rojas, no dolorosas y tienden a ubicarse en la conjuntiva superior o medial con un tamaño que varía entre 0,5-2,5 cm, como lo descrito en nuestro paciente 14,15 .…”