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Recurrence of infectious mononucleosis in adults after remission for 3 years:A case report

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World Journal of Clinical Cases 2022年第12期10卷 3951-3958页

作者： Xin-Yue Zhang Qi-Bei Teng Department of Traditional Chinese Medicine The Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center For Child HealthHangzhou 310052Zhejiang ProvinceChina Department of Hematology Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016Zhejiang ProvinceChina

BACKGROUND infectious mononucleosis(IM)is a disease caused by Epstein–Barr virus(EBV).EBV infection is common in children;however,it can cause IM in adults.Studies on recurrence of IM in adults after remission are limited.CASE SUMMARY We report a 28-year-old man who presented with IM-like symptoms with mild liver damage after initial remission of IM for 3 years.He was first diagnosed with IM and treated in 2015.Follow-up tests in 2016 and 2017 did not show any abnormalities.In November 2018,he presented with swelling of the tonsils.He was misdiagnosed with acute suppurative tonsillitis and treated for 5 d.No signs of improvement were observed.He was readmitted with recurrent fever,pharyngalgia,fatigue,and systemic muscle pain.Examinations revealed enlargement of the tonsils and cervical lymph nodes.Blood tests revealed elevated transaminase levels.Anti-EBV test was positive,indicating virus reactivation.IM recurrence was confirmed on the basis of laboratory tests and clinical manifestations.He was treated with antiviral,anti-infective,and hepatoprotective drugs and vitamin supplements.His condition improved and no abnormalities were observed during follow-up.CONCLUSION Recurrence of IM after remission is possible in adults;therefore,long-term followup and monitoring are essential.

关键词： Adults Epstein–Barr virus infectious mononucleosis Liver damage Recurrence Case report

Clinical characteristics and effectiveness of antiviral agents in hospitalized children with infectious mononucleosis in China:A multicenter retrospective study

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Pediatric Investigation 2021年第3期5卷 188-194页

作者： Huili Hu Huiling Deng Jing Bi Yi Xu Shuangjie Li Yue Xie Xinrong Sun Dongmeng Wang Xufang Li Wenxian Ouyang Bing Hu Yufeng Zhang He Tang Chunxiao Fang Hui Zhang Lingyun Guo Chen Wang Tianyi Wang Fengxia Yang Tao Jiang Zhengde Xie Gang Liu Key Laboratory of Major Diseases in Children Ministry of EducationResearch Unit of Critical Infection in ChildrenChinese Academy of Medical ScienceDepartment of Infectious DiseasesBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina Department of infectious Diseases Xi’an Children’s HospitalXi’anShaanxiChina Department of infectious Diseases Baoding Children’s HospitalBaodingHebeiChina Guangzhou Women and Children’s Medical Center GuangzhouGuangdongChina Hepatology Center Hunan Children’s HospitalChangshaHunanChina Beijing Key Laboratory of Pediatric Respiratory infectious Diseases Key Laboratory of Major Diseases in ChildrenMinistry of EducationNational Clinical Research Center for Respiratory DiseasesResearch Unit of Critical Infection in ChildrenChinese Academy of Medical Sciences2019RU016Laboratory of Infection and VirologyBeijing Pediatric Research InstituteBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina

Importance:The clinical characteristics of infectious mononucleosis(IM)in Chinese children have not been evaluated in multicenter studies,and the effectiveness of antiviral treatment are controversial.Objective:To investigate the clinical characteristics of Chinese children with IM and current status of antiviral therapy for affected patients.Methods:Hospitalized patients with IM were enrolled between 2018 and 2020 in five children’s hospitals in China.The clinical characteristics were compared among four age groups:<3 years,3-<6 years,6-<10 years,and≥10 years.The clinical characteristics of IM and effectiveness of antiviral therapy were compared among patients receiving acyclovir(ACV),ganciclovir(GCV),and no antiviral therapy(i.e.,non-antiviral group).Results:In total,499 patients were analyzed;most patients were 3-<6 years of age.The most common symptoms and signs included fever(100%),lymphadenopathy(98.6%),pharyngitis(86.4%),eyelid edema(76.8%),and snoring(72.9%).There were significant differences in rash,hepatomegaly,and liver dysfunction among the four age groups.Patients aged<3 years had a lower incidence of liver dysfunction and a higher incidence of rash.Among the 499 patients,50.1%were treated with GCV,26.3%were treated with ACV,and 23.6%received no antiviral therapy.Compared with the non-antiviral group,patients in the ACV and GCV groups had longer durations of fever(P<0.001).There were no significant differences in the incidences of complications among the three treatment groups.Interpretation:The incidence of IM in Chinese children peaked at 3-<6 years of age.Clinical features of IM varied according to age.Patients receiving antiviral therapy exhibited more serious clinical manifestations than did patients without antiviral therapy.The effectiveness of antiviral therapy for IM requires further analysis.

关键词： infectious mononucleosis Antiviral Ganciclovir Acyclovir

Dapsone-induced infectious mononucleosis-like syndrome in a patient with pemphigus vulgaris

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Chinese Medical Journal 2007年第12期120卷 1111-1113页

作者： ZHOU Jian-guang CAI Sui-qing ZHENG Min Department of Dermatology Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310009 China

Dapsone syndrome is characterized by high fever, skin rash, methemoglobinemia, liver toxicity, and generalized lymphadenopathy.The incidence of me dapsone syndrome is increasing with the extensive application of dapsone. However it is rarely reported in pemphigus. We present a case of ＂infectious mononucleosis-like＂ dapsone syndrome in a patient with pemphigus vulgaris. The syndrome appeared when he was being treated methylprednisolone, which was commonly used as a treatment for dapsone syndrome.

关键词： dapsone syndrome pemphigus vulgaris infectious mononucleosis

A Case of infectious mononucleosis Induced Jaundice Complicated by Possible Drug Induced Liver Injury (DILI)

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Open Journal of Clinical Diagnostics 2023年第4期13卷 89-98页

作者： Jyoti Upadhyay Amal Upadhyay Yusra Mashkoor Hamdan Iftikhar Siddiqui Department of Internal Medicine Aster Hospitals Dubai UAE Department of Gastroenterology Aster Hospitals Dubai UAE Medical Intern Dubai Health Authority (DHA) Dubai UAE

In this case, a young female presented with non-specific features such as fever, sore throat, headache and fatigue. She went on to develop epigastric pain, darkening of urine and jaundice, with no resolution of prior symptoms. Physical and Laboratory tests confirmed the primary diagnosis of infectious mononucleosis, however, prior history of treatment with multiple drugs led to a diagnosis of DILI as a complication. Appropriate treatment with I.V. antibiotics, hepatoprotective agents, steroids as well as discontinuation of all potential hepatotoxic agents showed significant improvement in patients’ symptoms and overall condition.

关键词： infectious mononucleosis Jaundice Drug Induced Liver Injury Lymphadenopathy

Diagnosis of infectious mononucleosis by Combined Detection of Atypical Lymphocytes and Transaminase

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2006年第3期26卷 384-385页

作者：胡丽华杨菊红崔天盆邢辉蔡鹏程 Department of Laboratory Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China

In order to explore the value of combined detection of atypical lymphocytes （ATL） and transaminase （alanine aminotransferase, ALT＇ asparate aminotransferase, AST） in the diagnosis of infectious mononucleosis （IM）, The data of blood routine and liver function were collected from 54 IM patients, 34 acute hepatitis （AH） patients, 44 upper respiratory infection （URI） patients in Union Hospital during March 2002 to March 2005. Same data were also collected from 40 healthy children as normal control. These data were analyzed retrospectively. Both proportion of atypical lymphocytes and enzyme activity of transaminase were elevated simultaneously （ALT〉40 IU/L, AST〉45 IU/L） in 57.4% （31/54） IM patients. There was significant difference （P〈0.01） between IM group and the other groups. Combined detection of atypical lymphocytes and transaminase can be regarded as a diagnostic marker of infectious mononucleosis.

关键词： atypical lymphocytes transaminase infectious mononucleosis

The sero-epidemiology of infectious mononucleosis in Neyshabur,Northeast Iran during 2010-2014

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Journal of Coastal Life Medicine 2016年第10期4卷 809-812页

作者： Mohammahd Salehi Mahtab Vafaei Abdolmajid Ghasemian Seyyed Khalil Shokouhi Mostafavi Research Center for HIV/AIDS HTLV and Viral HepatitisIranian Academic Center for EducationCulture and ResearchKhorasan Razavi BranchMashhadIran Medical Diagnostic Laboratory of Neyshabur Center of MedicalPathological and Genetic Diagnostic ServicesIranian Academic Center for EducationCulture and ResearchMashhad BranchMashhadIran Department of Virology Laboratory Sciences Keyvan Virology LaboratoryTehranIran Department of Microbiology Tehran Medical Sciences BranchIslamic Azad UniversityTehranIran

Objective:To detect infectious mononucleosis(IM)prevalence in Neyshabur,Northeast Iran during 2010-2014.Methods:This cross-sectional descriptive epidemiological survey was performed to reveal the prevalence of IM in Neyshabur between 2010 and 2014.A total of 114 individuals were studied.Briefly,individuals with positive test for specific immunoglobulin G and immunoglobulin M in the agglutination test were determined as positive cases.Results:The overall prevalence of IM was 14%.Mean±SD of age for IM test was 18.96±15.79.The age groups of 0-10 and 21-30 were the most positive cases in this period.In addition,31-40 and over 50 years were not positive cases.Male individuals were significantly more positive and likewise,it was observed that there were significantly higher positive cases of IM in spring and summer.Conclusions:Among the five years of this study,it was a decreasing status from 2010(23.1%)to 2014(9.1%),though a slight fluctuation had occurred.The prevalence of IM was low in Neyshabur City.Moreover,children and male individuals had relatively higher prevalence of the disease.Furthermore,it was observed a higher rate of IM in spring and summer.

关键词： Epstein-Barr virus infectious mononucleosis Neyshabur City Iran

A Case of infectious mononucleosis Complicated by Severe Thrombocytopenia and Hyperuricemia

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Open Journal of Blood Diseases 2016年第1期6卷 6-8页

作者： Vaia Papageorgiou Georgios Kaltsounis Konstantinos Loukidis Anna Kioumi Department of Hematology Papageorgiou General Hospital of Thessaloniki Thessaloniki Greece

infectious mononucleosis (IM) by Epstein-Barr virus is usually a benign, self-limiting disease. Mild to moderate immune thrombocytopenia in the setting of IM is very common and appears in approximately half of these patients, however it rarely presents in severe form and troublesome haemorrhage is even rarer. Rapid spontaneous resolution is possible, with the role of steroids being controversial. Furthermore, elevation of the levels of uric acid because of immune thrombocytopenia is observed in high frequency;however this finding is usually not mentioned. It is attributed to a transient increase in purine turnover, it appears more often in men (with its peak within the first 2 weeks of IM) and it is treated with intravenous fluids and bicarbonates. The present case report describes the case of a young female patient who develops severe thrombocytopenia and intense hyperuricemia following an Epstein-Barr infection. No severe bleeding appeared, levels of uric acid normalised within the first two weeks of treatment and platelet levels rise back to normal within a month under corticosteroid therapy.

关键词： infectious mononucleosis Thrombocytopenia Hyperuricemia Case Report

Epstein-Barr virus:Silent companion or causative agent of chronic liver disease?

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World Journal of Gastroenterology 2010年第33期16卷 4130-4134页

作者： Mihaela Petrova Victor Kamburov Clinic of Gastroenterology Ministry of Interior Gastroenterology Division First Multiprofile Hospital for Active Treatment

The Epstein-Barr virus(EBV)has an important and multifaceted role in liver pathology.As a member of the herpes virus family,EBV establishes a persistent infection in more than 90%of adults.Besides acute hepatitis during primary infection,many clinical syndromes of interest for the hepatologist are associated with EBV infection.The role of EBV in the evolution of chronic hepatitis from hepatotropic viruses is considered.Chronic EBVassociated hepatitis is suspected in immunocompetent adults with compatible serology,suggestive histology and detection of the viral genome in the liver and/or increase of specific circulating cytotoxic T-lymphocytes.EBV is the main cause of post-transplant lymphoproliferative disorders which occur in up to 30%of cases.EBV-driven lymphoproliferative diseases are also recognized in non-immunocompromised patients and liver is involved in up to a third of the cases.Directly implicated in the pathogenesis of different tumors,EBV has a disputable role in hepatocellular carcinoma carcinogenesis.Further research is required in order to establish or reject the role of EBV in human liver cancer.This paper attempts to discuss the range of EBV-associated chronic liver diseases in immunocompetent patients,from mild,self-limiting mononuclear hepatitis to liver cancer.

关键词： Epstein-Barr virus Chronic hepatitis Liver disease Chronic active Epstein-Barr virus Post-transplant lymphoproliferative disorder infectious mononucleosis

Celiac sprue-a cryptic disease:A case report

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World Journal of Medical Genetics 2022年第1期10卷 1-6页

作者： Lisa R Maness Clinical Laboratory Science Winston-Salem State UniversityWinston-SalemNC 27110United States

BACKGROUND Celiac sprue,or celiac disease,is a relatively common disease whereby many are unaware that they have it.It often manifests with symptoms outside of the digestive system.Many health care providers are unaware of the wide variety of symptoms of celiac disease as well as diseases that are associated with it,often delaying diagnosis and treatment.CASE SUMMARY The following case indicates an otherwise healthy 20-year-old female who presents with a variety of symptoms and is ultimately diagnosed with shingles,infectious mononucleosis,and celiac disease CONCLUSION Although it is known that risk-factors are genetic as well as environmental,much more research is needed to better understand the relationship of potential causes.In addition,continuing education is needed in health care so that more practitioners better understand celiac disease.

关键词： Celiac disease Autoimmune disease Shingles infectious mononucleosis Case report