Severe Respiratory Insufficiency Complicating Epstein-Barr Virus Infection: Case Report and Review

Abstract

We report a case involving a young adult who had life-threatening bilateral pneumonitis in the course of an acute Epstein-Barr virus (EBV) infection. Because of severe hypoxemia, the patient required mechanical ventilation and additional oxygenation by an intravascular oxygenator. The patient was treated with corticosteroids and survived without sequelae. Severe pulmonary involvement associated with EBV infection is a rare but potentially fatal complication of infectious mononucleosis. Similar cases reported in the literature are reviewed, and the therapeutic options for this particular complication are discussed.Infectious mononucleosis is a worldwide, highly prevalent herpesvirus infection caused by Epstein-Barr virus (EBV). The disease is the result of a primary infection that occurs mostly early in life. During childhood, nonspecific symptoms or even a subclinical course prevail, whereas in adolescents the disease often leads to considerable morbidity [I]. Typically, the patients present with the triad of fever, pharyngitis, and lymphadenopathy, and splenomegaly is usually found on physical examination. Secondary immunologic responses are thought to play an important role in complicated courses, which may affect the heart, brain, and other organs [2,3]. Severe clinical courses with complications requiring hospital treatment occur in merely 5% of the cases; however, only 100 fatal outcomes have been registered in the United States during a period of 10 years [4][5][6]. Case fatalities occur mainly in association with fulminant hepatitis, encephalitis, hemophagocytic syndrome, and splenic rupture [7][8][9][10].Recently, we took care of a young, otherwise healthy adult who had life-threatening pneumonitis with severe hypoxemia in the course of an acute EBV infection. By exclusion of other causative agents, the pulmonary involvement was considered to be an EBV-related complication. Just a few similar cases have been reported in the literature; these are reviewed. Case ReportIn January 1994 a 30-year-old student at a police academy presented because of a lO-day history of fever, sore throat, swelling of the cervical lymph nodes, myalgias, and fatigue. He was seen by a physician, who prescribed a macrolide antibi- otic that produced no improvement in the patient's condition. Cough and progressive dyspnea developed, and he was admitted to another hospital, where bilateral pneumonia with marked partial respiratory insufficiency (arterial partial pressure of oxygen [Pao-], 5.32 kPa; arterial partial pressure of CO 2 , 3.8 kPa; and arterial blood saturation with oxygen [Sao-], 78%) was diagnosed. Therapy with amoxicillin/clavulanic acid was begun. Because of progressive respiratory failure, the patient was intubated and mechanically ventilated. Hypoxemia persisted (Pao-, 7.0 kPa, despite an FI02 of 1.0), and the patient was transferred to our hospital.On admission, the patient was noted to have well-developed muscles. He was orally intubated. The pulse rate was 100; blood pressure, 140/80 mm Hg; and temperature, 37°C....

Virus-associated Hemophagocytic Syndrome in an International Traveler as a Differential Diagnosis of SARS

“…The findings of the chest radiograph have been explained by mononuclear infiltrations predominantly in the perivascular, peribronchial tissues and the intraalveolar septa (13). Severe respiratory insufficiency complicating EBV infection has also been reported (13). A substantial part of these clinical and radiographic findings are similar to those of SARS, and were observed in the present case.…”

“…Common chest radiograph findings included alveolar-interstitial opacities with pleural effusions, often with rapid evolution and resolution (12). The findings of the chest radiograph have been explained by mononuclear infiltrations predominantly in the perivascular, peribronchial tissues and the intraalveolar septa (13). Severe respiratory insufficiency complicating EBV infection has also been reported (13).…”

Acute Epstein–Barr virus infection presenting as severe gastroenteritis without infectious mononucleosis-like manifestations

“…EBV infects and immortalizes human B lymphocytes, and EBV-infected cells are targets of specific cytotoxic T lymphocytes [2]. IM is a self-limiting clinical syndrome that is occasionally compounded by rare severe complications involving the hematologic, neurological, renal, and respiratory systems [3][4][5]. However, a predominant gastrointestinal (GI) manifestation of primary EBV infection is rarely reported [6][7][8][9].…”

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“…The efficacy of corticosteroids in treatment of viral pneumonia, including influenza virus pneumonia, is still controversial. Several reports supported the findings that the improvement of arterial oxygenation leads to a good prognosis (8,(12)(13)(14). Other reports reject its efficacy (7,15).…”