Epstein-Barr Virüsüne Bağlı Atipik Klinik Tablolar

Abstract

Introduction: Epstein-Barr virus (EBV) infection is usually asymptomatic in childhood. The best known disease caused by EBV is infec- tious mononucleosis (IM), which usually presents with fever, membranous tonsillitis, and diffuse lymphadenopathy. Apart from that, EBV may cause atypical clinical features by involving different organ systems. Here, we aimed to present and discuss our EBV cases with atypical presentations. Materials and Methods: The study was performed retrospectively. Patients who were diagnosed with infectious mononucleosis by history, physical examination and serology, and those with EBV-related disorders who were investigated for fever of unknown cause, lymphadenopathy, hematological disorder or isolated hypertransaminasemia were not included into the study. The diagnosis was made by EBV serology. The finding of an EBV viral capsid antigen IgM positivity was accepted as consistent with an acute EBV infection. The study included 7 different cases. Three of the cases had different neurological involvements, whereas the remaining four cases had myositis, pleural effusion, cholecystitis and preorbital cellulitis. Results: The first case, a 3-year-old boy with complaints of fever for a week, impaired speech and ataxia for two days was diagnosed as EBV meningoencephalitis. The second case, a 10-year-old girl, presented with fever, cough, weakness for a week, and dizziness, ataxia, metamorphosis, choreiform movements in the arms and legs and convulsions for one day. Following advanced investigations, her clinic was found to be related with EBV. The third case, a 14-year-old boy, presented with pain in the left eye and blurred vision for a week. He had papilledema and raised intracranial pressure. The fourth case, an 8-year-old boy, was hospitalized with the complaints of fever, nasal discharge for three days, and leg pain and difficulty in walking for the last day. Creatine phosphokinase level was found to be high, and he was diagnosed with myositis. The fifth case, a 15-year-old girl, had respiratory distress that started 10 days ago. In further investigations (including for tuberculosis) of pleural effusion that did not regress with antibiotic treatment, no underlying cause other than EBV was found. The sixth case, a 7-year-old girl, presented with a week-long fever, epigastric and right upper quad- rant abdominal pain. She was diagnosed with acute acalculous cholecystitis caused by EBV. The seventh case, an 8-year-old girl, was hospitalized with complaints of redness and swelling in the left eye for five days, and was diagnosed as periorbital cellulitis. Her clinical picture was thought to be caused by EBV. Conclusion: This study shows that meningoencephalitis, chorea, raised intracranial pressure, myositis, pleural effusion, cholecystitis or periorbital cellulitis may occur in children infected with EBV infection. We would like to emphasize that considering EBV in the etiology of such cases may prevent unnecessary examinations, treatments and interventions.