Severe thrombocytopenia as a complication of acute Epstein-Barr virus infection

Abstract

Severe thrombocytopenia is an extremely rare complication of acute Epstein-Barr virus (EBV) infection. EBV infection usually causes hematological abnormalities, mainly atypical lymphocytosis, which is a feature of infectious mononucleosis, and uncomplicated cases often present with mild decreases in platelet counts. Our otherwise healthy, 21-year-old male Caucasian patient had thrombocytopenia and bleeding diathesis with platelet counts of 8 x 10(9)/L without other signs and symptoms of infectious mononucleosis. We commenced treatment with intravenous methylprednisolone before the acute EBV infection was serologically confirmed. Platelet counts initially rose and then fell after we stopped administrating corticosteroids. Repeated administration of methylprednisolone was followed by full recovery of the platelet count and normalization of formerly elevated transaminases. EBV infection may happen in children, adolescents and adults and this differential diagnosis should be considered in every patient presenting with acute thrombocytopenia.

The Influence of Primary Cytomegalovirus or Epstein-Barr Virus Infection on the Course of Idiopathic Thrombocytopenic Purpura

“…These symptoms occurred more frequently in patients infected with EBV. In the studies by other authors, thrombocytopenia has been followed by clinically overt infectious mononucleosis (Likic and Kuzmanic 2004;Takahashi et al 2008). In the literature, CMV and EBV infections are described as risk factors for resistance to treatment, severe course, hemorrhagic complications, and death in children and adults with ITP (DiMaggio et al 2009;Brodkiewicz et al 2009;Walter et al 2004).…”

“…In terms of serological status, infections caused by viruses mentioned above are divided into primary, reactivated, persistent, history, or just susceptibility to infection (seronegative). It is believed that CMV and EBV viruses may be a common cause of autoimmune thrombocytopenia due to the phenomenon of antigenic mimicry stimulating the production of antiplatelet antibodies (Sheng Yu et al 2008;Likic andKuzmanic 2004, Wu et al 2013;Cines et al 2009). The destructive role of T cells and impaired production of platelets are mentioned as the processes responsible for the occurrence of ITP (Rodeghiero et al 2009).…”

Severe thrombocytopenia and recurrent epistaxis associated with primary Epstein-Barr virus infection

“…The most significant aspect of this case was that the patient presented with a severe thrombocytopenia with haemorrhagic sequelae (recurrent spontaneous epistaxis). Although a mild deficiency in platelet count occurs in 25–30% of EBV cases, the more severe form is incredibly rare 2. We carried out a PubMed search looking at precisely this correlation, finding 31 cases of EBV associated with severe haemorrhagic and/or life-threatening thrombocytopenia dating back to 1990 3–28.…”

“…This is supported by serological evidence, as well as BioMedical Admissions Test (BMAT) analysis almost always demonstrating evidence of peripheral platelet consumption. The fact that only 40% of these patients have demonstrable antiplatelet antibodies has also led some proponents to advocate splenic sequestration secondary to hypersplenism as a significant contributor, although many patients also have normal-sized spleens on ultrasound 2. There is subsequently a belief that EBV present in the bone marrow may impair platelet generation and function 29…”

“…In a small number of individuals, however, a variety of moderate to severe haematological, neurological, hepatic, respiratory and psychological complications can arise 2. The diagnosis is often made clinically, together with a positive rapid heterophile antibody test (monospot); although immunofluorescence assays of the IgM and IgG antibodies against the viral capsid antigen (VCA) of EBV or amplification of EBV DNA via quantitative real-time PCR (qPCR) are useful if the clinical picture is uncertain 1…”