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Case Report
 
A rare case of fulminant primary Epstein–Barr virus infection in a young adult
Jason Tan1, Chaminda Basnayake2
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.

Article ID: 100017CRINTJT2015
doi:10.5348/crint-2015-17-CR-12

Address correspondence to:
Jason Jun'an Tan
The Queen Elizabeth Hospital. 28 Woodville Road
Woodville South
South Australia
Australia 5011
Phone: +6182226000
Fax: +6182226126

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How to cite this article:
Tan J, Basnayake C. A rare case of fulminant primary Epstein–Barr virus infection in a young adult. Case Rep Int 2015;4:47–51.


Abstract
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-year-old 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, 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 life-threatening consequences. Clinicians treating patients with primary EBV infection should remain vigilant in monitoring and treating severe complications.

Keywords: Coagulopathy, Epstein-Barr virus, Haemoptysis, Infection, Liver failure, Retropharyngeal abscess


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Author Contributions
Jason Tan – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Chaminda Basnayake – Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Jason Tan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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