Presenter Status
Resident/Psychology Intern
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Carina Perdew
Presentation Type
Poster
Start Date
20-5-2026 11:00 AM
End Date
20-5-2026 12:00 PM
Abstract Text
Background: Epstein-Barr virus (EBV) infects over 90% of individuals worldwide. Acute EBV infection results in lifelong latent infection, but rarely causes chronic active EBV (CAEBV) infection or immunodeficiency-associated B-cell lymphoproliferative disease. There is no standard treatment approach, making the diagnosis and management of CAEBV challenging.
Objectives/Goal: Upon completion of this session, our aim is for audience members be able to discuss a rare complication of EBV infections and to better formulate management approaches for this multifaceted condition.
Methods/Design: Case Report
Results: A 15-year-old female with a history of atopic dermatitis, headaches, and secondary amenorrhea was hospitalized for persistent tachycardia and daily fevers for one month. Her physical exam was unremarkable.
The initial work-up demonstrated leukopenia, anemia, elevated inflammatory markers, transaminases, and LDH. EBV serologies demonstrated a prior infection. Immunology labs showed low naive CD4+ and CD8+ T-cells, memory B and switched memory B-cells, elevated Immunoglobulin G, soluble Interleukin-2R, CXCL9, and EBV PCR (383,000 DNA copies/mL). Bone marrow aspirate and whole-body PET/CT scan returned unremarkable. She started immunosuppressive therapy without improvement and completed 6 weeks of valacyclovir with little change in EBV viral load.
Over a year later, her recurrent fevers persisted. Her EBV PCR sent for cell-type differentiation demonstrated EBV-infected T- and NK-cells. Repeat labs demonstrated low NK cell counts and clonal TCR rearrangement. Bone marrow biopsy visualized trilineage hematopoiesis, increased lymphocyte infiltrate, and EBER+ T- and NK-cells; findings supporting CAEBV diagnosis. She completed chemotherapy followed by allogeneic bone marrow transplant, and currently demonstrate adequate disease control.
Conclusions: CAEBV is characterized by clonal proliferation of EBV-infected T and/or NK cells, leading to multi-organ infiltration and systemic inflammation in the absence of genetically confirmed immunodeficiency. The clinical course may be heterogeneous, thus a high index of suspicion is important for management of this potentially life-threatening illness.
Clinical Course of a Previously Healthy Patient with Chronic Active EBV Infection
Background: Epstein-Barr virus (EBV) infects over 90% of individuals worldwide. Acute EBV infection results in lifelong latent infection, but rarely causes chronic active EBV (CAEBV) infection or immunodeficiency-associated B-cell lymphoproliferative disease. There is no standard treatment approach, making the diagnosis and management of CAEBV challenging.
Objectives/Goal: Upon completion of this session, our aim is for audience members be able to discuss a rare complication of EBV infections and to better formulate management approaches for this multifaceted condition.
Methods/Design: Case Report
Results: A 15-year-old female with a history of atopic dermatitis, headaches, and secondary amenorrhea was hospitalized for persistent tachycardia and daily fevers for one month. Her physical exam was unremarkable.
The initial work-up demonstrated leukopenia, anemia, elevated inflammatory markers, transaminases, and LDH. EBV serologies demonstrated a prior infection. Immunology labs showed low naive CD4+ and CD8+ T-cells, memory B and switched memory B-cells, elevated Immunoglobulin G, soluble Interleukin-2R, CXCL9, and EBV PCR (383,000 DNA copies/mL). Bone marrow aspirate and whole-body PET/CT scan returned unremarkable. She started immunosuppressive therapy without improvement and completed 6 weeks of valacyclovir with little change in EBV viral load.
Over a year later, her recurrent fevers persisted. Her EBV PCR sent for cell-type differentiation demonstrated EBV-infected T- and NK-cells. Repeat labs demonstrated low NK cell counts and clonal TCR rearrangement. Bone marrow biopsy visualized trilineage hematopoiesis, increased lymphocyte infiltrate, and EBER+ T- and NK-cells; findings supporting CAEBV diagnosis. She completed chemotherapy followed by allogeneic bone marrow transplant, and currently demonstrate adequate disease control.
Conclusions: CAEBV is characterized by clonal proliferation of EBV-infected T and/or NK cells, leading to multi-organ infiltration and systemic inflammation in the absence of genetically confirmed immunodeficiency. The clinical course may be heterogeneous, thus a high index of suspicion is important for management of this potentially life-threatening illness.
Comments
Poster Board Number: 3