Complicated EBV infection in a healthy child

• Published in: BMJ case reports Vol. 14; no. 3; p. e241099
• Main Authors: Teles, Hugo, Brito, Teresa, Cachão, Joana, Parente, Susana
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 18-03-2021; BMJ Publishing Group
• Subjects: Abdomen; Antibiotics; Asymptomatic; Blood tests; Cardiac arrhythmia; Case Report; Case reports; Child; Cholecystitis, Acute; Ejection fraction; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - diagnosis; Female; Fever; Gallbladder; Gallbladder diseases; Herpesvirus 4, Human; Humans; Infections; Lymphatic system; Mononucleosis; Myocarditis; Neutrophils; Pain; Pediatrics; Serology; Tonsillitis; Tonsillitis - drug therapy; Ultrasonography; Viral infections; infections; cardiovascular system; paediatrics (drugs and medicines); paediatric intensive care
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-241099

The Epstein-Barr virus (EBV) is highly prevalent throughout the population. Although in most cases, the infection has a good prognosis, it can cause severe complications. We report a case of a healthy child with a primary EBV infection that evolved with two rare complications. She first presented in the emergency room with fever and sore throat, and was diagnosed with tonsillitis and medicated with antibiotic. She returned 7 days later for fatigue, vomiting and abdominal pain. The examination revealed tonsillitis, swollen cervical lymph nodes and pain in the right hypochondrium. An abdominal ultrasound was performed, compatible with acute acalculous cholecystitis. She was admitted in the paediatric nursery and medicated with intravenous antibiotics. The EBV serology revealed primary infection. Two days later, she developed cardiogenic shock and had to be transferred to an intensive care unit under mechanical ventilation and inotropics. She was discharged 12 days later, keeping a moderate left ventricular dysfunction.