AN UNUSUAL
PRESENTATION OF EBV INFECTION IN AN 11 MONTH OLD INFANT: A CASE REPORT
Papadakis E, Mila
M, Korovessi P, Tsagris V, Xenofonte C, Xanthaki, Zoidou A
Thriasio General
Hospital, Athens, Greece
Primary infection with EBV in childhhod is
generally silent but can often cause overt diseases such as infectious
mononucleosis and lymphoproliferative disorders. In developed countries
primary infection of EBV is usually delayed untill adolescence.Neurologic
complications are relatively rare in children with EBV infections, occuring
aproximately in 8% of those infected.The incidence of facial nerve palsy
associated with EBV infection is unknown,although in one study concerning the complications in
children with EBV infection, the incidence was found 0.9%. We present an 11 month old
infant with a 4 days history of fever, 2 days history of facial weakness
and mild cough.Physical examination revealed small cervical lymphnodes, (L)
otitis media and (L) facial nerve palsy.Neurological examination was otherwise
normal.No generalised lymphadenopathy was found.Liver was palpable 2 cm
below the costal margin and there was no splenomegaly. His previous medical
history was unremarcable.There was no evidence of immunodeficiency and he
has not received any cytotoxic or steroid medication . Initial laboratoty tests showed marked
leucocytosis with atypical lymphocytes.WBC: 82100/¦Ìl with lymphocytes: 70.9%. The
hemoglobin was 11.5 g/dl and platelets 284000/¦Ìl.
CRP and ESR were not raised.
Hepatic transaminases were slightly elevated: SGOT: 76U/L,SGPT: 58U/L.
Primary EBV infection was established by serologic examination for specific EBVantibodies: VCA-IgM(+),
VCA-IgG:1/320, EA<1/20,EBNA<1/20. Bone marrow aspirates showed
increased number of polyclonal B lymphocytes and no malignant
infiltration.Also no monoclonality of the B lymphocyte was detected either
by flowcytometry immunophenotype or immunoglobulin gene rearangement.
Chromosomal analysis was normal. Serologic examination for other viral
infections such as HSV,CMV, HIVand Hepatitis A,B,C were negative.Ther was
no evidence of Lyme disease. Middle ear fluid was obtained by tympanocentesis
was sterile on culture. Facial nerve palsy gradually resolved with no
treatment and WBC returned to normal after 3 weeks time.During the
following 6 months the patient had 2 episodes with similar clinical and
hematological findings.
Conclusion: This is a
rare presentation of recurrent EBV infection with extreme leucocytosis and
facial nerve palsy.