Case Report: Pediatric Chronic Active Epstein-Barr Virus Infection With Giant Sinus of Valsalva Aneurysms and Aorta and Its Branch Dilations

Abstract

Chronic active Epstein-Barr virus infection (CAEBV), which often manifests as persistent infectious mononucleosis-like symptoms and can involve multiple organs, is a prolonged or reactivated status of primary EBV infection. Cardiovascular damage is one of the rare but severe complications correlated with poor prognosis among all CAEBV patients. Few published articles have demonstrated systemic arterial lesions involving branches of the aorta as cardiovascular complications. Herein, we report a rare pediatric case of CAEBV associated with giant sinus of Valsalva aneurysms and aorta and its branch dilations.

Cardiovascular involvement in Epstein–Barr virus infection

“…According to the available literature, although EBV is a rare but recognized cause of pericarditis, which can lead to pericardial effusion and even cardiac tamponade, it was detected in the pericardial effusion in only a few patients ( 14 , 15 ). In addition, valvular heart disease associated with EBV, which may be primary or secondary, is mainly considered to be induced by EBV-associated vasculitis despite limited evidence in patients with CAEBV or EBV-HLH ( 8 , 21 , 23 , 31 ). Heart failure is a symptom and sign of cardiac dysfunction.…”

“…The databases Pubmed, Embase, Web of Science, Sino-Med, Cochrane, CNKI, VIP, and Wangfang Data were searched to gather data on cardiovascular damage brought on by EBV infection from inception to November 2022. There were 28 articles (with a total of 54 patients included) reporting EBV-associated cardiovascular damage: 17 from China ( 7 , 8 , 13 , 19 , 21 – 31 , 34 , 35 ), one from Morocco ( 12 ), two from Italy ( 6 , 17 ), one from Australia ( 13 ), three from America ( 14 , 18 , 33 ), one from England ( 15 ), and three from Japan ( 9 , 16 , 20 ). There were 10 (18.5%) adults ( 6 , 12 – 20 ) and 44 (71.5%) children (under 18 years old) ( 7 – 9 , 21 – 35 ), ranging in age from 1 year and 5 months to 67 years.…”

“…There were 28 articles (with a total of 54 patients included) reporting EBV-associated cardiovascular damage: 17 from China ( 7 , 8 , 13 , 19 , 21 – 31 , 34 , 35 ), one from Morocco ( 12 ), two from Italy ( 6 , 17 ), one from Australia ( 13 ), three from America ( 14 , 18 , 33 ), one from England ( 15 ), and three from Japan ( 9 , 16 , 20 ). There were 10 (18.5%) adults ( 6 , 12 – 20 ) and 44 (71.5%) children (under 18 years old) ( 7 – 9 , 21 – 35 ), ranging in age from 1 year and 5 months to 67 years. In terms of sex, there were 28 male ( 7 , 12 , 16 , 18 , 20 , 23 , 25 , 27 , 28 , 30 – 34 ) and 26 female patients ( 6 , 8 , 9 , 13 , 15 , 17 , 19 , 21 , 22 , 24 , 26 – 29 , 31 , 35 ).…”

“…There were 10 (18.5%) adults ( 6 , 12 – 20 ) and 44 (71.5%) children (under 18 years old) ( 7 – 9 , 21 – 35 ), ranging in age from 1 year and 5 months to 67 years. In terms of sex, there were 28 male ( 7 , 12 , 16 , 18 , 20 , 23 , 25 , 27 , 28 , 30 – 34 ) and 26 female patients ( 6 , 8 , 9 , 13 , 15 , 17 , 19 , 21 , 22 , 24 , 26 – 29 , 31 , 35 ). Regarding the diagnosis of EBV infection, 23 (42.6%) were diagnosed with AEBV ( 6 , 13 – 15 , 17 , 18 , 25 , 27 , 32 ), 20 (37.0%) with CAEBV ( 7 , 8 , 16 , 19 – 22 , 28 – 31 , 34 ), 6 (11.1%) had a complication of CAEBV and HLH ( 12 , 24 , 28 , 31 ), 4 (7.4%) had a diagnosis of EBV-HLH ( 9 , 23 , 33 , 35 ), and 1 (1.9%) had reactivated EBV ( 26 ).…”

“…We retrieved 18 articles (with 44 included patients) reporting EBV-associated CAI, including 15 from China ( 7 , 8 , 21 – 31 , 34 , 35 ), two from Japan ( 9 , 16 ), and one from Morocco ( 12 ). Of the included patients, 42 (95.5%) were children ( 7 – 9 , 21 – 31 , 34 , 35 ) and two (4.5%) were adults ( 12 , 16 ).…”