Severe Thrombocytopenia in a Young Patient with EBV Induced Infectious Mononucleosis: An Extremely Rare and Life-threatening Complication

Asghar Marwat^1, , Hassan Mehmood¹ and Muzammil Khan¹

¹Department of Internal Medicine, Temple University/ Conemaugh Memorial Medical Center, 1086 Franklin Street, Johnstown, PA, USA, 15905

Cite this paper

Asghar Marwat, Hassan Mehmood and Muzammil Khan. Severe Thrombocytopenia in a Young Patient with EBV Induced Infectious Mononucleosis: An Extremely Rare and Life-threatening Complication. American Journal of Medical Case Reports. 2018; 6(2):24-25. doi: 10.12691/AJMCR-6-2-3

Abstract

Epstein-Barr virus is a widely disseminated herpes virus. Humans are the main reservoir. Acute infectious mononucleosis is one of the most common presentations of acute EBV infection. Although mild thrombocytopenia is a common complication of EBV induced infectious mononucleosis, severe thrombocytopenia with counts less than 25,000/mm³ is extremely rare and infrequently reported. We herein, present a 22-year-old Caucasian male with no past medical history who came to our hospital with complaints of fever, sore throat, swollen lymph nodes and intermittent bleeding from his gums for the last 4 weeks. On physical examination, the patient had enlarged tonsils and cervical lymphadenopathy, however, no rashes or hepatosplenomegaly were noted. On initial Lab work the patient had a platelet count of 11,000/mm³, WBC count of 9,800 with 31% atypical Lymphocytes and a positive mono spot test. The patient also had a peripheral smear showing marked thrombocytopenia. EBV infection was further confirmed by serology including EBV-PCR. Other possible causes of thrombocytopenia including HIV and Hepatitis C were tested and found to be negative. The patient was treated with platelet transfusion and intravenous steroids. He was discharged three days later, after his platelet count improved to 36,000/mm³ on a tapering dose of steroids. Two weeks later repeat lab work revealed that his platelet count had dropped again significantly to 2000/mm³. He was readmitted and this time treated with Intravenous Immunoglobulin and intravenous steroids. The patient had dramatic improvement and his platelet count was 143,000/mm³ two days later. The patient was discharged and continued to have normal platelet counts during routine clinic follow ups few months later. Severe thrombocytopenia is a potentially life-threatening condition. Although exceptionally rare, severe thrombocytopenia can occur as a complication of EBV induced Infectious mononucleosis and should be considered by physicians as a possible differential for thrombocytopenia in the right clinical setting. Steroids and Intravenous Immunoglobulin have been used with varying success to treat this complication.

Keywords

thrombocytopenia AND EBV infection

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Odumade OA, Hogquist KA, Balfour HH Jr. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin Microbiol Rev 2011; 24:193.
[2]	Dunmire SK, Hogquist KA, Balfour HH. Infectious Mononucleosis. Curr Top Microbiol Immunol 2015; 390:211.
[3]	Carter RL: Platelet Levels in infectious mononucleosis. Blood 1965; 25:817-821.
[4]	Pipp ML, Means ND, Sixbey JW, Morris KL, Gue CL, Baddour LM. Acute Epstein-Barr virus infection complicated by severe thrombocytopenia. Clin Infect Dis. 1997 Nov; 25(5): 1237-9.
[5]	Steeper TA, Horwitz CA, Moore SB, et al: Severe thrombocytopenia in Epstein-Barr virus-induced mononucleosis. West J Med 1989 Feb; 150:170-173
[6]	Miller G, Shope T, Lisco H, et al. Epstein-Barr virus: transformation, cytopathic changes, and viral antigens in squirrel monkey and marmoset leukocytes. Proc Natl Acad Sci U S A 1972; 69: 383.
[7]	Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med 2010; 362: 1993.
[8]	Williamson DR, Albert M, Heels-Ansdell D, et al. Thrombocytopenia in critically ill patients receiving thromboprophylaxis: frequency, risk factors, and outcomes. Chest 2013; 144: 1207.
[9]	Neunert C, Noroozi N, Norman G, et al. Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review. J Thromb Haemost 2015; 13:457.
[10]	Mazza J, Magnin G. Severe thrombocytopenia in infection mononucleosis. Wis Med J 1975; 74: 124-127.