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Published on: September 7, 2022
Complicated EBV infection in a healthy child
Hugo Teles1, Teresa Brito1, Joana Cachão2
1Pediatrics Department, Centro Hospitalar de Setubal EPE, Setubal, Portugal.
Insights
A healthy child experienced a primary Epstein-Barr virus (EBV) infection, leading to rare complications including acute acalculous cholecystitis and cardiogenic shock. This case highlights potential severe outcomes of EBV in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Epstein-Barr virus (EBV) is a common virus with generally benign outcomes.
- Primary EBV infections can occasionally lead to severe complications, particularly in children.
Observation:
- A previously healthy child presented with symptoms of tonsillitis and fever, initially treated with antibiotics.
- The child later developed fatigue, vomiting, abdominal pain, and was diagnosed with acute acalculous cholecystitis.
- Rapid deterioration occurred, leading to cardiogenic shock requiring intensive care and mechanical ventilation.
Findings:
- EBV serology confirmed a primary infection.
- The patient experienced two rare complications: acute acalculous cholecystitis and cardiogenic shock.
- Post-intensive care, the child exhibited moderate left ventricular dysfunction.
Implications:
- This case underscores the potential for severe, multi-systemic complications from primary EBV infection in children.
- It emphasizes the importance of considering EBV in pediatric patients presenting with unusual symptoms and complications.
- Early recognition and aggressive management are crucial for improving outcomes in severe EBV cases.
Abstract:
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.
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