Chronic interstitial lung disease due to Epstein-Barr virus infection in two infants

A Pfleger1, E Eber, H Popper

  • 1Paediatric Department, University of Graz, Austria.

Insights

Epstein-Barr virus (EBV) caused chronic interstitial lung disease in two infants. One infant recovered with antiviral treatment, while the other improved spontaneously, showing long-term symptom resolution.

Area of Science:

  • Pediatrics
  • Virology
  • Pulmonology

Background:

  • Chronic interstitial lung disease (chILD) in infants is challenging to diagnose and manage.
  • Epstein-Barr virus (EBV) is a common human herpesvirus, typically associated with infectious mononucleosis, but its role in infant lung disease is less understood.

Observation:

  • Two infants, aged 5 and 6 months, presented with failure to thrive, tachypnea, rales, and mild hypoxemia, indicative of significant respiratory distress.
  • Diagnostic investigations revealed Epstein-Barr virus (EBV) in lung biopsy and bronchoalveolar lavage (BAL) fluid via in situ hybridization and PCR.
  • Serological tests confirmed immunoglobulin G antibodies to EBV capsid antigen in both infants.

Findings:

  • One infant received a 10-day course of intravenous ganciclovir followed by oral acyclovir for 20 days, leading to successful recovery after 7 months of respiratory symptoms.
  • The second infant resolved symptoms spontaneously within 3.5 months without specific antiviral therapy.
  • Both infants remained symptom-free with normal physical development during follow-up periods of 2 years and 1.5 years, respectively.

Implications:

  • This case study suggests EBV as a potential causative agent in infant chronic interstitial lung disease.
  • The findings highlight the possibility of spontaneous resolution and the efficacy of antiviral treatment (ganciclovir and acyclovir) in managing EBV-associated infant lung disease.
  • Further research is warranted to elucidate the pathogenesis of EBV in chILD and to establish optimal treatment guidelines.

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