Clinical Observation |

Epstein-Barr Viral Load Assessment in Immunocompetent Patients With Fulminant Infectious Mononucleosis

Jan A. M. van Laar, MD, PhD; Corinne M. P. Buysse, MD; Ann C. T. M. Vossen, MD, PhD; Björn Hjálmarsson, MD; Bart van den Berg, MD, PhD; Kirsten van Lom, PhD; Jaap Deinum, MD, PhD
Arch Intern Med. 2002;162(7):837-839. doi:10.1001/archinte.162.7.837.
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We describe 2 immunocompetent adolescents with fulminant infectious mononucleosis and virus-associated hemophagocytosis. A new quantitative polymerase chain reaction revealed high serum Epstein-Barr virus DNA levels in these patients. One patient died with an increasing viral load not responding to corticosteroids followed by antiviral and intensified immunomodulatory treatment. The other patient received corticosteroids and acyclovir at diagnosis; her rapid recovery was heralded by a steep decline of viral load. We propose monitoring the clinical course of fulminant infectious mononucleosis in immunocompetent patients by Epstein-Barr virus DNA quantification and prompt corticosteroid and antiviral therapy when viral load is high.

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Figure 1.

Clinical events and serum Epstein-Barr virus DNA (viral load) detected by real-time polymerase chain reaction in 2 patients with fulminant infectious mononucleosis.

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Figure 2.

Bone marrow specimen with phagocytosis of platelets, erythroblasts, and erythrocytes by macrophages in patient 2 with fulminant infectious mononucleosis.

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