SHM Converge Scientific Abstract ePoster Gallery-Return of the Kissing Disease Culprit: An Ebv Reactivation

Pdf Summary

This case describes an unusual Epstein-Barr virus (EBV) reactivation in a previously healthy 63-year-old man. He presented with two weeks of worsening malaise, diffuse tender lymphadenopathy, diarrhea, shortness of breath, and decreased urine output despite empiric treatment for a tick-borne illness. On examination, he had widespread lymph node enlargement, edema, abdominal distension, and signs of respiratory distress. Laboratory studies showed leukocytosis, thrombocytopenia, acute kidney injury, microscopic hematuria, and electrolyte abnormalities. Extensive infectious, rheumatologic, and hematologic workup was negative except for a positive EBV PCR.<br /><br />Because of his age, bulky generalized lymphadenopathy, and elevated EBV viral load, clinicians initially suspected an EBV-associated malignancy or tumor lysis syndrome. However, multiple tissue samples, including peripheral blood flow cytometry, lymph node biopsies, and kidney biopsy, showed no evidence of lymphoma or carcinoma. The kidney biopsy instead suggested acute interstitial nephritis with hypersensitivity features and foot process effacement.<br /><br />Imaging showed diffuse mediastinal, cervical, abdominal, pelvic, and inguinal lymphadenopathy, as well as hepatosplenomegaly and small pleural effusions, reinforcing concern for cancer. Despite this, the patient improved without chemotherapy. After broad-spectrum antibiotics were stopped and supportive care continued, his lymphadenopathy diminished and his renal and respiratory failure resolved.<br /><br />The authors conclude that this was a severe EBV reactivation rather than malignancy. The case highlights that EBV should remain in the differential diagnosis of older adults with unexplained lymphadenopathy and systemic symptoms, even when findings are dramatic and cancer is strongly suspected. It also emphasizes that EBV-related kidney injury can present as acute interstitial nephritis and should be considered in patients with EBV infection who develop elevated creatinine or oliguria.

Asset Subtitle

Elizabeth Douglas

Meta Tag

Author List Colin Burnett, Elizabeth Douglas, Joshua Lyons, Meghna Trivedi, Rohit Das

Category Clinical Vignettes

Concept Epstein-Barr Virus

Concept Diffuse Lymphadenopathy

Concept Acute Interstitial Nephritis

Concept Reactivation

Concept Kidney Injury

Distinguished Non-Finalist

Presenter Organization UMass Memorial Worcester

Presenting Author Elizabeth Douglas

Track Adult

Keywords

Epstein-Barr virus

EBV reactivation

lymphadenopathy

acute interstitial nephritis

kidney injury

hepatosplenomegaly

lymphoma differential

viral load

renal failure

older adult

Epstein-Barr Virus

Diffuse Lymphadenopathy

Acute Interstitial Nephritis

Reactivation

Kidney Injury