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  • Massive splenomegaly due to concurrent primary Epstein-Barr virus and cytomegalovirus infection in a patient on adalimumab

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Unusual presentation of more common disease/injury
CASE REPORT
Massive splenomegaly due to concurrent primary Epstein-Barr virus and cytomegalovirus infection in a patient on adalimumab
  1. Barathy Rani Ramasamy1,
  2. Patrick Charles1,2,
  3. Douglas Johnson1,2,
  4. Albert Frauman3,4
  1. 1Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
  2. 2Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
  3. 3Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
  4. 4Acute Medical Group, Cabrini Hospital, Malvern, Victoria, Australia
  1. Correspondence to Dr Barathy Rani Ramasamy, barathyrani{at}gmail.com

Summary

A 32-year-old man who was receiving adalimumab for seronegative rheumatoid arthritis presented with a 4-week history of fever, night sweats, fatigue, myalgias and diarrhoea. On examination, he had obvious splenomegaly but no lymphadenopathy or pharyngitis. Full blood count revealed mild neutropenia and significant lymphocytosis, with a blood film showing atypical lymphocytes. Liver function tests were mildly deranged with a mixed hepatitic and obstructive pattern. Ultrasound confirmed massive splenomegaly with a span of 21 cm in the long axis. Serological tests confirmed the presence of both primary Epstein-Barr virus and cytomegalovirus infections. The patient had his adalimumab withheld, was treated with supportive measures and improved over a period of 8 weeks. He remained well 5 months after the onset of illness with complete normalisation of blood count and a resolution of the splenomegaly.

  • unwanted effects / adverse reactions
  • rheumatoid arthritis
  • Infectious diseases

https://doi.org/10.1136/bcr-2017-220184

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    Footnotes

    • Contributors BRR and AF were responsible for providing medical care to the patient during his hospital stay at Cabrini Hospital, Malvern. The idea for the case report was courtesy of AF and BRR. BRR takes responsibility for the clinical details of the case.A brief literature search was conducted by DJ and BRR and the case was identified as unusual. The initial content was authored by BRR, and BRR was responsible for a conducting a detailed literature review on the subject matter. The interpretation of the serological was testing was done with the aid of DJ and PC. PC was responsible for editing most of the manuscript with contributions from DJ and AF. The final version of the manuscript was approved by all four authors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.