Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2023; 11(17): 4090-4097
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4090
Epstein-Barr virus-induced infection-associated hemophagocytic lymphohistiocytosis with acute liver injury: A case report
Fang-Yuan Sun, Bing-Qing Ouyang, Xiao-Xiao Li, Tao Zhang, Wen-Tao Feng, Yao-Guo Han
Fang-Yuan Sun, Bing-Qing Ouyang, Xiao-Xiao Li, Tao Zhang, Wen-Tao Feng, Yao-Guo Han, Trauma Emergency Center, The Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
Author contributions: Sun FY and OuYang BQ contributed equally to this work; Sun FY, OuYang BQ, Li XX, Zhang T and Feng WT designed the research study; Li XX, Zhang T, Feng WT, and Han YG performed the research; Li XX, Zhang T contributed new reagents and analytic tools; Sun FY and OuYang BQ analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 82174189; Talents Training Program of Seventh People’ s Hospital of Shanghai University of Traditional Chinese Medicine, No. JCR2022-01; TCM Specialist Disease Alliance Construction Project of Shanghai Municipal Health Commission, No. ZY (2021-2023)-0302; Talent Training Project of Senior Master of Chinese Medicine of Shanghai Pudong, No. PDZY-2022-0601; and Project of Introducing Senior Talents of Chinese Medicine of Shanghai Pudong, No. PDZY-2022-0701; and Talents Training Program of the Seventh People’ s Hospital, Shanghai University of Traditional Chinese Medicine, No. QMX2021-04.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yao-Guo Han, PhD, Doctor, Trauma Emergency Center, The Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine, No. 358 Datong Road, Shanghai 200137, China. hanyaoguo@163.com
Received: March 9, 2023
Peer-review started: March 9, 2023
First decision: April 10, 2023
Revised: April 25, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: June 16, 2023
Processing time: 93 Days and 1.8 Hours
Abstract
BACKGROUND

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory reaction, which is rare and life-threatening. According to the pathogen, HLH is divided into genetic and acquired. The most common form of acquired HLH is infection-associated HLH, of which Herpes viruses, particularly Epstein-Barr virus (EBV), are the leading infectious triggers. However, it is difficult to distinguish between simple infection with EBV and EBV-induced infection-associated HLH since both can destroy the whole-body system, particularly the liver, thereby increasing the difficulty of diagnosis and treatment.

CASE SUMMARY

This paper elaborates a case about EBV-induced infection-associated HLH and acute liver injury, aiming to propose clinical guides for the early detection and treatment of patients with EBV-induced infection-associated HLH. The patient was categorized as acquired hemophagocytic syndrome in adults. After the ganciclovir antiviral treatment combined with meropenem antibacterial therapy and methylprednisolone inhibition to inflammatory response, gamma globulin enhanced immunotherapy, the patient recovered.

CONCLUSION

From the diagnosis and treatment of this patient, attention should be paid to routine EBV detection and a further comprehensive understanding of the disease as well as early recognition and early initiation are keys to patients’ survival.

Keywords: Epstein-Barr virus; Hemophagocytic lymphohistiocytosis; Computed tomography; Case report

Core Tip: Most Epstein-Barr virus (EBV) infection resolves spontaneous complications. We report a unique case of hemophagocytic lymphohistiocytosis (HLH) complicating EBV infection and acute liver injury. EBV-associated acute liver injury is rare, occurs in children and young adults usually, and has conservative management. It is equivocal in distinguishing simple infection with EBV and EBV-induced infection-associated HLH. The doctor only cares about the symptoms of his/her personal clinical experience and ignores the detection of the EBV, thus, the optimal treatment miss. It is appropriate to comprehend the nature of the malady, searching for the primary cause of the disease in treatment.