Persistent transfusion-associated infectious mononucleosis with transient acquired immunodeficiency

Area of Science:

• Immunology
• Virology
• Infectious Diseases

Background:

• Trauma and splenectomy can induce transient immune deficiency.
• Blood transfusions carry a risk of pathogen transmission, including viruses like Epstein-Barr virus (EBV).
• Infectious mononucleosis is a common illness, typically self-limiting, caused by EBV.

Observation:

• A 21-year-old male experienced severe, persistent infectious mononucleosis following trauma and a blood transfusion.
• The patient had a history of splenectomy and a fractured tibia complicated by osteomyelitis.
• EBV antibodies were detected 25 days post-transfusion, coinciding with the onset of prolonged infectious mononucleosis.

Findings:

• The patient's infectious mononucleosis persisted for nearly two years, indicating a profound and prolonged immune response to EBV.
• Acquired, transient immune deficiency to EBV was inferred as a contributing factor.
• Despite recovery from infectious mononucleosis, the patient required amputation due to a persistent fracture infection (Staphylococcus aureus).

Implications:

• This case suggests that acquired immune deficiency, even if transient, can lead to severe EBV-related illness.
• The clinical presentation is analogous to inherited immune deficiencies, such as X-linked lymphoproliferative syndrome, in response to EBV.
• Understanding the interplay between trauma, transfusion, and immune status is crucial for managing infectious complications.