Imaging spectrum of EBV-infection in a young patient

Abstract

A wide variety of atypical presentations with complications affecting multiple organ systems during acute infectious mononucleosis (IM) is described in the literature, with an increase in the number of teenagers who are susceptible to a severe case of the disease. We report a case of a 14-year-old girl with severe IM and acute abdominal pain. Ultrasonographic (US) evaluation showed a marked thickening of the gallbladder wall (GBW) with enlargement of some mesenteric lymph nodes. CT scan showed multiple enlarged lung nodules of various sizes and a small pleural and pericardial effusion; a hypodense solid mass of unknown etiology was detected in the anterior mediastinum, mimicking a malignant tumor. Hematological analysis of peripheral blood smear was performed to exclude neoplastic pathology. IM was identified as the only underlying disease. The patient was carefully monitored: clinical evaluation, laboratory analysis and US examination were repeated at weekly intervals, until recovery.Sommario Gli adolescenti possono talvolta presentare forme aggressive di mononucleosi infettiva (MI), che si manifestano con quadri atipici e aspecifici e si accompagnano a complicanze di diversa gravità a carico di vari organi e apparati. Riportiamo il caso di una ragazza di 14 anni, giunta alla nostra osservazione per un quadro di mononucleosi infettiva (MI) e dolore addominale acuto; le indagini diagnostiche evidenziavano all'ecografia addominale la presenza di ispessimento della parete colecistica (>3 mm) con versamento pericolecistico e di linfonodi ingranditi all'ilo epatico; alla TC veniva confermato il quadro ecografico addominale e si evidenziava inoltre una massa solida ipodensa a livello del mediastino anteriore, con versamento pleurico e pericardico e presenza di numerosi linfonodi mediastinici ingranditi. Data la gravità del quadro, è stato necessario escludere patologie neoplastiche. La paziente è stata attentamente monitorizzata durante la degenza, ed ha presentato una completa, ma lenta risoluzione dei sintomi. ª

Pleural effusions induced by human herpesviruses in the immunocompetent host

“…monospot and serology testing confirmed the diagnosis. A similar case, involving a teenage girl, was described by Pellicia et al [46]. Ascites, pleural and pericardial effusion were noted.…”

Multiple Pulmonary Nodules in an Immunocompetent Adolescent with Infectious Mononucleosis

“…Pulmonary nodules occurring in immunocompetent children as part of EBV is rarely reported in literature. Pelliccia, et al [2] described a 14-year-old girl with EBV positive IMN with multiple pulmonary nodules as well as mild pericardial effusion and hydrops of gall bladder, all of which resolved on follow up . Shinozuka, et al [3] described a case of multiple lung nodules in an adolescent with IMN which spontaneously regressed over a two year period.…”

Spontaneous Regression of Pulmonary Nodules Presenting as Epstein-Barr Virus-related Atypical Infectious Mononucleosis

“…nodules, and peritoneal effusion, all clinical signs that have been reported previously in patients with atypical EBV-IM. [3][4][5][6] Along with pulmonary nodules, the patient showed high serum levels of b-D-glucan, which are generally noted in pulmonary fungal infections or pneumocystis pneumonia. In this case, such infectious diseases were unlikely and the serum levels of b-D-glucan normalized with the regression of pulmonary nodules, indicating that it might have reflected the activity of EBV-infected pulmonary nodules.…”

“…1 Atypical clinical presentations of EBV-IM in apparently healthy young adolescents and adults include leukopenia, pulmonary nodules, gastritis, gall bladder thickening, peritoneal effusion, or hemophagocytic lymphohistiocytosis. [2][3][4][5][6][7] The outcome of clinically typical EBV-IM is usually self-limiting, whereas that of atypical IM varies. The variable manifestations of atypical EBV-IM rarely lead clinicians to suspect primary EBV infection.…”