Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Epstein Barr Virus (EBV) is a widely disseminated virus known to cause infectious mononucleosis and a range of associated conditions. Autoimmune hemolytic anemia (AIHA) is a rare complication of EBV infection, with only a small percentage of cases reported in the literature. We present a unique case of a young female patient with a complex autoimmune pattern, later found to be associated with EBV.
Case Presentation: A 22-year-old Hispanic female with no past medical history presented to the Emergency Department with generalized weakness, nausea, left upper quadrant pain, and jaundice progressing for one week. Physical examination revealed scleral icterus, jaundice, and splenomegaly. Laboratory tests indicated microcytic anemia, abnormal liver enzymes, high levels of serum lactate dehydrogenase, and bilirubinuria. Extensive workup ruled out common viral etiologies, narrowing down the differentials to an autoimmune pathology causing hemolytic anemia coexisting with hepatitis. Further investigations revealed Coombs-negative AIHA. Flow cytometry showed activated T cells, supporting a reactive condition such as viral infection. Treatment involved initiating oral steroids for immunosuppression and iron replenishment. The patient showed clinical improvement with declining liver enzymes and was discharged for outpatient follow-up. A positive Epstein Barr virus PCR test confirmed EBV as the likely trigger for the autoimmune cascade. Discussion: EBV infection can occasionally initiate an autoimmune cascade, leading to conditions such as AIHA and hepatitis. While infectious mononucleosis commonly presents with fever, pharyngitis, and lymphadenopathy, our patient lacked these typical features. The pathophysiology of Coombs-negative AIHA remains uncertain, but low antibody titers may contribute to negative test results. Our case highlights the successful use of oral steroids without transfusion and the potential need for additional treatments in more severe cases. The importance of considering a broad range of differentials and maintaining a high clinical suspicion is emphasized.
Conclusion: Early diagnosis and treatment based on clinical suspicion are crucial in cases of EBV-associated AIHA with hepatic dysfunction. Immunosuppression with steroids should be considered as a potential therapeutic approach. Despite limited reports in the literature, recognizing the coexistence of EBV-associated Coombs-negative AIHA with hepatitis is important. Further studies are needed to explore this association in a larger population.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Alexander, Blesset; Bartl, Mery; Alshaikhli, Alfarooq; and Lopez, Michelle, "Navigating the Viral Maze: A Twisted Tale of EBV-Induced Autoimmune Hemolytic Anemia with Hepatitis" (2024). Research Symposium. 9.
https://scholarworks.utrgv.edu/somrs/2023/posters/9
Included in
Navigating the Viral Maze: A Twisted Tale of EBV-Induced Autoimmune Hemolytic Anemia with Hepatitis
Background: Epstein Barr Virus (EBV) is a widely disseminated virus known to cause infectious mononucleosis and a range of associated conditions. Autoimmune hemolytic anemia (AIHA) is a rare complication of EBV infection, with only a small percentage of cases reported in the literature. We present a unique case of a young female patient with a complex autoimmune pattern, later found to be associated with EBV.
Case Presentation: A 22-year-old Hispanic female with no past medical history presented to the Emergency Department with generalized weakness, nausea, left upper quadrant pain, and jaundice progressing for one week. Physical examination revealed scleral icterus, jaundice, and splenomegaly. Laboratory tests indicated microcytic anemia, abnormal liver enzymes, high levels of serum lactate dehydrogenase, and bilirubinuria. Extensive workup ruled out common viral etiologies, narrowing down the differentials to an autoimmune pathology causing hemolytic anemia coexisting with hepatitis. Further investigations revealed Coombs-negative AIHA. Flow cytometry showed activated T cells, supporting a reactive condition such as viral infection. Treatment involved initiating oral steroids for immunosuppression and iron replenishment. The patient showed clinical improvement with declining liver enzymes and was discharged for outpatient follow-up. A positive Epstein Barr virus PCR test confirmed EBV as the likely trigger for the autoimmune cascade. Discussion: EBV infection can occasionally initiate an autoimmune cascade, leading to conditions such as AIHA and hepatitis. While infectious mononucleosis commonly presents with fever, pharyngitis, and lymphadenopathy, our patient lacked these typical features. The pathophysiology of Coombs-negative AIHA remains uncertain, but low antibody titers may contribute to negative test results. Our case highlights the successful use of oral steroids without transfusion and the potential need for additional treatments in more severe cases. The importance of considering a broad range of differentials and maintaining a high clinical suspicion is emphasized.
Conclusion: Early diagnosis and treatment based on clinical suspicion are crucial in cases of EBV-associated AIHA with hepatic dysfunction. Immunosuppression with steroids should be considered as a potential therapeutic approach. Despite limited reports in the literature, recognizing the coexistence of EBV-associated Coombs-negative AIHA with hepatitis is important. Further studies are needed to explore this association in a larger population.