Chronic active EB virus infection in a child with the onset of IgA nephropathy
10.3760/cma.j.cn441217-20230621-00631
- VernacularTitle:以IgA肾病起病的儿童慢性活动性EB病毒感染1例
- Author:
Shuying FAN
1
;
Xin WANG
;
Ning WEI
;
Qiumei ZHOU
;
Wenhong WANG
Author Information
1. 天津市儿童医院，天津大学儿童医院肾脏内科 天津市儿科研究所 天津市儿童出生缺陷防治重点实验室，天津 300134
- Keywords:
Herpesvirus 4, human;
Glomerulonephritis, IgA;
Child
- From:
Chinese Journal of Nephrology
2024;40(2):137-140
- CountryChina
- Language:Chinese
-
Abstract:
Chronic active Epstein-Barr virus (CAEBV) infection with renal involvement is not common. The paper reported a child of multisystem-compromised CAEBV infection with the onset of IgA nephropathy (IgAN). The child presented with intermittent gross hematuria, and renal biopsy showed focal proliferative IgAN, administered methylprednisolone pulse followed by oral prednisolone treatment. Intermittent increase of blood Epstein-Barr virus (EBV) load and abnormal EBV antibody, pneumonia caused by EBV and Staphylococcus aureus-mixed infection, periappendiceal abscess, and pancytopenia occurred during treatment follow-up. The CAEBV infection was considered. Echocardiography suggested pulmonary hypertension. Head CT presented multiple calcifications in the bilateral basal ganglia. Bone marrow biopsy showed bone marrow EBV-DNA 6.5×10 3 copies per liter. Immunohistochemistry of renal biopsy showed about 50 CD8 + (scattered +) cells per high power field (HPF), about 40 CD4 + (focal +) cells per HPF (local), CD68 + (-), latent membrane protein 1 (-), EBV-encoded small RNA (scattered +) approximately 25 cells per HPF. The lymphocyte subsets infected with EBV showed CD4 + T cells EBV-DNA 3.4×10 4 copies per 1 million cells, CD8 + T cells EBV-DNA 3.3×10 5 copies per 1 million cells, B cells EBV-DNA 1.25×10 4 copies per 1 million cells, NK cells/NK T cells EBV-DNA 2.3×10 4 copies per 1 million cells. The clinical diagnosis was CAEBV infection and EBV-associated IgAN. The patient currently receives oral prednisone treatment, and it is recommended to undergo hematopoietic stem cell transplantation and treatment is under follow up.
