A rare case of fulminant primary Epstein–Barr virus infection in a young adult

Introduction: Primary Epstein–barr virus (EbV) infection usually manifests in adolescents and young adults as infectious mononucleosis which classically presents as a syndrome of fever, pharyngitis, lymphadenopathy, fatigue and atypical lymphocytosis. the vast majority of patients have relatively mild disease. However, it may rarely present as a fulminant infection with severe multi-organ manifestations. case report: We report a rare case of a young woman admitted under our care in hospital with severe primary EbV infection. A 20-yearold female with no significant past medical history presented with a three-week history of worsening sore throat, ear pain, non-productive cough, fever, nausea, generalized myalgia and lethargy. serology confirmed that she had acute EbV infection. During her admission, she developed complications of fulminant hepatic failure, coagulopathy, retropharyngeal abscess, ulcerative glossitis and pulmonary consolidation resulting in hemoptysis and sepsis which required intensive care unit management. With aggressive antibiotic and supportive therapy, she made a full recovery. conclusion: this is the first case report documenting the concurrent presence of severe multi-system involvement in primary EbV infection including hepatic, haematological, Jason Tan1, Chaminda Basnayake2 Affiliations: 1Senior Registrar, Division of Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Jason; 2Staff Consultant, Division of Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia. Corresponding Author: Jason Jun’an Tan, The Queen Elizabeth Hospital. 28 Woodville Road, Woodville South, South Australia, Australia 5011, Ph: +6182226000; Fax: +6182226126; E-mail: [email protected] Received: 16 June 2015 Accepted: 27 July 2015 Published: 27 October 2015 upper and lower respiratory tract. Despite the benign course of disease in the vast majority of patients with primary EbV infection, this case highlights the need for clinicians to be aware of the possibility of fulminant disease with severe multi-organ involvement with potential lifethreatening consequences. clinicians treating patients with primary EbV infection should remain vigilant in monitoring and treating severe complications.