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Abstract: The patient in this case is a 16-year-old girl who presented to the hospital with an acute onset of fever and malaise for 7 days as the main complaints. She had been examined in an outside hospital and was found to have abnormal liver function, positive EBV DNA, enlarged superficial lymph nodes, splenomegaly, and an elevated lymphocyte ratio. The diagnosis was EBV infection. After giving antiviral + liver protection + enzyme lowering treatment, the patient’s symptoms improved and the liver function improved on recheck.
Basic information】Female, 16 years old
Disease Type】EB virus infection
Hospital】Liaoning Provincial People’s Hospital
Time of consultation】September 2018
Treatment plan】Medication (busulfan anti-inflammatory oral solution, compound dichloroacetate diisopropylamine injection, polyenyl phosphatidylcholine injection, magnesium isoglycyrrhizate injection)
[Treatment Period] 12 days of hospitalization and 2 weeks of outpatient follow-up
Treatment effect] Symptoms improved, liver function improved on review
I. Initial consultation
The patient is a 16-year-old girl who came to our hospital with complaints of fever and malaise for 7 days. Patient’s description: 7 days ago, she developed fever with a maximum temperature of 38.9℃, accompanied by malaise and loss of appetite. 2 days after the fever lasted, her temperature decreased. 3 days ago, she went to an outside hospital for examination and found abnormal liver function, ALT: 179U/L and positive EBV DNA. Ultrasound: enlarged lymph nodes in both necks and left supraclavicular fossa, enlarged spleen. He was treated with oral silymarin capsules, dicyclomine tablets and pidomod oral solution, and is currently fever-free, but still weak. The liver function was still abnormal on recheck. He came to the clinic for further treatment and was initially diagnosed with EBV infection. He was admitted to the ward after communicating with his family.
II. Treatment history
After admission, the patient was first isolated and treated according to the treatment of respiratory infectious diseases, and was advised to rest in bed and eat a light diet. Afterwards, the patient’s blood tests were completed. The routine blood tests showed that the patient was infected with the virus and the lymphocytes were mainly elevated. Combined with the EBV DNA test results and the patient’s related clinical manifestations, the diagnosis of EBV infection was clarified.
The treatment plan is as follows: antiviral + liver preservation + enzyme lowering treatment, give Pudilan anti-inflammatory oral solution orally, antiviral treatment; give compound dichloroacetate diisopropylamine injection, polyenyl phosphatidylcholine injection, magnesium isoglycyrrhizate injection intravenous drip, in order to achieve liver preservation and enzyme lowering purpose.
(Blood routine)
(Liver function)
III. Treatment effect
After 7 days of systematic and active treatment, the patient had obvious effect, symptoms improved significantly, and liver function improved on recheck, so the antiviral drugs could be stopped. Continued liver protection and enzyme reduction, etc. At 11 days of admission, the indicators were rechecked: blood routine prompted: white blood cell count: 6.16×10^9/L; lymphocytes returned to normal. The liver function test was normal: glutamic aminotransferase: 24.7 U/L, glutamic oxalacetic aminotransferase: 18.9 U/L, alkaline phosphatase: 116 U/L, transpeptidase: 107 U/L, total bilirubin: 16.4 μmol/L, creatine kinase: 31 U/L (↓), and the indexes gradually returned to normal. In conclusion, the patient was hospitalized for a total of 12 days, and the patient’s condition was controlled and liver function gradually improved.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. EBV infection is self-limiting and most of them have a good prognosis. In EB infection, the infection is mainly contracted through close oral-oral contact, and the detoxification time is more often and can reach several months, so it is also important to try to keep a distance from the family for a period of time after discharge, mainly avoiding oral-oral contact, especially with children in the family, or immunocompromised patients. After discharge, it is necessary to take rest and gradually increase the amount of exercise to avoid fatigue. 2 weeks later, liver function, EBV DNA measurement, and liver, biliary and spleen ultrasound should be reviewed to assess whether liver function and splenomegaly have improved.
V. Personal insight
Because EBV infection has been found to be an increasing proportion of clinical cases in recent years, and usually in children and adolescents, with clinical manifestations of infectious mononucleosis, attention needs to be paid to spleen rupture. In adults, EBV infection is more common in adults with liver injury. In addition, many people who are found to have positive EBV antibodies on inpatient testing usually indicate previous EBV infection, and most positive antibodies are a sign of previous infection; only the presence of positive coat antigen IgM (VCA-IgM) and early antigen antibody (EA-IgG) is indicative of recent infection and has clinical significance.