SHM Converge Scientific Abstract ePoster Gallery-Rapid Onset Thrombocytopenia Following Epstein-Barr Virus Reactivation

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This case describes a 63-year-old man admitted for dizziness due to heart failure exacerbation who was found to have an abrupt platelet drop during hospitalization. His platelet count was 141,000 on admission and fell to 51,000 within 72 hours, while hemoglobin, white blood cells, coagulation studies, hemolysis labs, and abdominal exam remained stable. He had recently recovered from mild gastroenteritis, and there was no heparin exposure, bruising, bleeding, hepatosplenomegaly, or lymphadenopathy.<br /><br />EBV testing suggested reactivation/infection: EBV VCA IgG, EBNA IgG, and EBV early antigen IgG were elevated, and EBV DNA PCR was detected. Although steroids were considered because of reports of EBV-associated thrombocytopenia, treatment was deferred because the patient was asymptomatic and the thrombocytopenia was borderline rather than severe. The platelet count stabilized within 24 hours, rose to 152,000 by day 6, and normalized to 264,000 one week later without intervention.<br /><br />The authors note that mild thrombocytopenia is relatively common in EBV infection, but severe, rapid declines are uncommon and may occur without classic symptoms of EBV such as lymphadenopathy or splenomegaly. This case supports that EBV-related thrombocytopenia can progress quickly and resemble heparin-induced thrombocytopenia in its abruptness. It also suggests that steroid therapy should be reserved for patients with severe thrombocytopenia or clinical bleeding, since some patients may recover spontaneously with observation alone.

Asset Subtitle

Alex L. Chang

Meta Tag

Author List Alex L. Chang, Arun Madari, Atsumi Kimura, Mark P. Cubillan, Tarif Anzum

Category Clinical Vignettes

Concept Epstein-Barr Virus

Concept Thrombocytopenia

Concept Reactivation

Concept Platelet Count

Concept Serology

Distinguished Non-Finalist

Presenter Organization Zucker School of Medicine at Hofstra/Northwell

Presenting Author Alex L. Chang

Track Adult

Keywords

Epstein-Barr virus

thrombocytopenia

platelet drop

reactivation

heart failure

dizziness

steroid therapy

heparin-induced thrombocytopenia

viral infection

observation

Epstein-Barr Virus

Thrombocytopenia

Reactivation

Platelet Count

Serology