SHM Converge Scientific Abstract ePoster Gallery-Febrile Connection? A Case of Persistent Ebv and Acute Kidney Injury

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This case report describes a 24-year-old woman with eight weeks of nausea and fevers, followed by night sweats, cyclical fevers, and weight loss after a positive monospot test and EBV serologies suggesting prior infection. On presentation, she had acute kidney injury with creatinine 4.14 mg/dL from a baseline of 0.82, anemia, elevated inflammatory markers, and urinalysis showing pyuria and WBC casts. Imaging and extensive infectious, rheumatologic, and autoimmune workup were unrevealing.<br /><br />Because her renal function did not improve with IV fluids and she continued to have fevers, a renal biopsy was performed. The biopsy showed interstitial inflammation with eosinophils consistent with acute interstitial nephritis (AIN), with minor acute tubular necrosis. She was treated with high-dose prednisone and her creatinine improved rapidly to 1.14 within one week.<br /><br />The report emphasizes that Epstein-Barr virus (EBV)–associated AIN is rare and is mainly described in case reports. The mechanism may involve direct viral injury or immune-mediated damage. Symptoms of EBV infection usually resolve within 2 to 4 weeks, but persistent or worsening systemic symptoms, especially with acute kidney injury, should raise concern for EBV-related AIN. However, urinalysis findings such as pyuria, WBC casts, and eosinophilia are not specific, making renal biopsy necessary for diagnosis.<br /><br />Treatment with corticosteroids is the standard approach for AIN, and most patients recover kidney function fully, though some have incomplete recovery or irreversible damage. The authors conclude that EBV should be considered as a rare cause of AIN in patients with persistent EBV-like symptoms and no other clear cause of kidney injury, and that renal function should be checked when symptoms do not resolve as expected.

Asset Subtitle

Jennifer L. Spiegel

Meta Tag

Author List Christine Donahue, Dhruval Amin, Jason Kurland, Jennifer L. Spiegel, Morgan Groover, Shubha Dave

Category Clinical Vignettes

Concept Epstein-Barr Virus Infection

Concept Acute Interstitial Nephritis

Concept Acute Kidney Injury

Concept Kidney Biopsy

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization University of Massachusetts Chan Medical School

Presenting Author Jennifer L. Spiegel

Track Adult

Keywords

Epstein-Barr virus

acute interstitial nephritis

acute kidney injury

renal biopsy

prednisone

pyuria

WBC casts

eosinophils

creatinine

case report

Epstein-Barr Virus Infection

Acute Interstitial Nephritis

Acute Kidney Injury

Kidney Biopsy

Corticosteroids