SHM Converge Scientific Abstract ePoster Gallery-Severe Pancytopenia Secondary to Epstein-Barr Virus

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This case describes an 18-year-old previously healthy male with Epstein-Barr virus infectious mononucleosis (EBV-IM) who developed unusually severe pancytopenia. He initially presented with sore throat, fever, nausea, vomiting, headache, and dysphagia, after having been diagnosed with mononucleosis about a month earlier and treated briefly with prednisone. On admission, he was febrile, tachycardic, and found to have profound pancytopenia: WBC 500/μL, hemoglobin 8.8 g/dL, ANC 10/μL, and platelets 6,000/μL, along with hyponatremia and mild acute kidney injury.<br /><br />A broad workup was performed to evaluate infectious, hematologic, and other causes of marrow suppression. EBV IgM and IgG were positive, while testing for adenovirus, COVID, CMV, hepatitis B/C, HIV, strep, DAT, PNH, histoplasma, and blastomyces was negative. Imaging showed tonsillar swelling consistent with mononucleosis but no hepatosplenomegaly or chest abnormalities. Because the pancytopenia persisted, a bone marrow biopsy was obtained and demonstrated hypocellular marrow with trilineage hypoplasia, without evidence of hematolymphoid malignancy.<br /><br />He was treated for neutropenic fever with broad-spectrum antibiotics and later antifungal and antiviral prophylaxis, along with growth-factor support (Neupogen and Promacta) to aid marrow recovery.<br /><br />The report emphasizes that while EBV-IM commonly causes fever, pharyngitis, lymphadenopathy, and mild cytopenias, severe pancytopenia and aplastic anemia-like marrow suppression are rare in immunocompetent patients. The key lesson is that EBV-related pancytopenia can complicate diagnosis and management, and early thorough evaluation is essential to prevent superinfection and support recovery.

Asset Subtitle

Nana Danso

Meta Tag

Author List Antoni Wojtkowski, Brian W. Quinn, Hari Anandarajah, Nana Danso

Category Clinical Vignettes

Concept Epstein-Barr virus infectious mononucleosis

Concept Pancytopenia

Concept Neutropenia

Concept Thrombocytopenia

Concept Bone Marrow Biopsy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Nana Danso

Track Adult

Keywords

Epstein-Barr virus

infectious mononucleosis

pancytopenia

aplastic anemia

bone marrow biopsy

hypocellular marrow

trilineage hypoplasia

neutropenic fever

marrow suppression

immunocompetent patient

Epstein-Barr virus infectious mononucleosis

Pancytopenia

Neutropenia

Thrombocytopenia

Bone Marrow Biopsy