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Clinical analysis of chronic active EBV infection with coronary artery dilatation and a matched case-control study
Ang Wei1, Honghao Ma1, Liping Zhang1
1Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, People's Republic of China.
Insights
Chronic active Epstein-Barr Virus infection (CAEBV) with coronary artery dilatation (CAD) is rare in children and does not impact prognosis. High early levels of LDH, ferritin, TNF-α, and IL-10 may indicate a higher risk for developing CAD.
Area of Science:
- Pediatric Infectious Diseases
- Cardiology
- Oncology
Background:
- Chronic active Epstein-Barr Virus infection (CAEBV) is a severe condition with potential systemic complications.
- Coronary artery dilatation (CAD) is a recognized, albeit infrequent, manifestation of CAEBV in pediatric cases.
- Understanding the interplay between CAEBV and CAD is crucial for timely diagnosis and management.
Purpose of the Study:
- To investigate the clinical characteristics, treatment, and prognosis of children with CAEBV and associated CAD.
- To identify potential risk factors for the development of CAD in pediatric CAEBV patients.
- To compare outcomes between CAEBV patients with and without CAD.
Main Methods:
- Retrospective analysis of pediatric patients with CAEBV and CAD hospitalized between March 2016 and December 2019.
- Matching CAEBV patients with CAD to a control group of CAEBV patients without CAD based on sex, age, treatment, and admission time.
- Collection and comparison of clinical manifestations, laboratory results (including EBV-DNA, LDH, ferritin, TNF-α, IL-10), ultrasound findings, treatment strategies, and patient outcomes.
Main Results:
- Ten children (8.9%) were diagnosed with CAEBV and CAD, with a median onset age of 6.05 years.
- All patients exhibited high EBV-DNA levels; 8 out of 10 had bilateral CAD.
- While CAD resolved in 3 patients after treatment (median 21 days), elevated LDH, ferritin, TNF-α, and IL-10 levels were significantly associated with CAD development (P < 0.05). Survival rates did not differ significantly between groups (P = 0.416).
Conclusions:
- The incidence of CAEBV-associated CAD in children is low.
- CAEBV-associated CAD does not appear to negatively influence the overall prognosis of CAEBV.
- Elevated LDH, serum ferritin, TNF-α, and IL-10 levels early in the disease course are potential risk factors for developing CAD in children with CAEBV.
Objective:
To investigate the clinical characteristics, treatment, prognosis and risk factors for chronic active Epstein-Barr Virus infection (CAEBV) associated with coronary artery dilatation (CAD) in children.
Methods:
Children with CAEBV associated with CAD hospitalized at Beijing Children's Hospital, Capital Medical University from March 2016 to December 2019 were analyzed. Children with CAEBV without CAD were selected as the control group and matched by sex, age, treatment and admission time. The clinical manifestations, laboratory and ultrasound examinations, treatment and prognosis of the children were collected in both groups.
Results:
There were 10 children with CAEBV combined with CAD, including 6 males and 4 females, accounting for 8.9% (10/112) of CAEBV patients in the same period, with an onset age of 6.05 (2.8-14.3) years. The median follow-up time was 20 (6-48) months. All the patients had high copies of EBV-DNA in whole blood [1.18 × 107 (1.90 × 105-3.96 × 107) copies/mL] and plasma [1.81 × 104 (1.54 × 103-1.76 × 106) copies/mL], and all biopsy samples (bone marrow, lymph nodes or liver) were all positive for Epstein-Barr virus-encoded small RNA. Among the 10 children, 8 had bilateral CAD, and 2 patients had unilateral CAD. After diagnosis, 7 children were treated with L-DEP chemotherapy in our hospital. After chemotherapy, four patients underwent allogeneic hematopoietic stem cell transplantation (HSCT). The others were waiting for HSCT. At the time of the last patients follow up record, the CAD had returned to normal in 3 patients, and the time from the diagnosis of CAD to recovery was 21 (18-68) days. LDH, serum ferritin, TNF-α and IL-10 levels were statistically significantly different between the two groups (P = 0.009, 0.008, 0.026 and 0.030). There were no significant differences in survival rate between the two groups (P = 0.416).
Conclusion:
The incidence of CAEBV with CAD was low. CAEBV with CAD did not influence the prognosis. Patients who had high LDH, serum ferritin, TNF-α, and IL-10 levels early in their illness were more likely to develop CAD.
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