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Chronic active Epstein-Barr virus: a multidisciplinary approach
  1. Jessica Wauchope,
  2. Colm Brendan Dorris,
  3. Caroline Patricia Smith and
  4. Brendan Hanna
  1. ENT Department, Royal Victoria Hospital, Belfast, UK
  1. Correspondence to Jessica Wauchope; jwauchope02{at}


A 17-year-old Caucasian male presented to ENT with angular stomatitis, oral ulceration and cervical lymphadenopathy. Over the subsequent 18 months he developed recurrent upper respiratory tract infections, pyrexia of unknown origin, oral ulceration and maxillary sinus osteomyelitis. Extensive investigation ensued from various specialties. Positive investigations included a mild but persistently elevated serum Epstein-Barr virus PCR; however, no unifying diagnosis was elicited. It is noteworthy that a significant factor contributing to a delay in his diagnosis was poor compliance with invasive investigations. Ultimately, deteriorating liver function prompted liver biopsy which confirmed a diagnosis of chronic active Epstein-Barr virus infection (CAEBV). This enabled referral for curative treatment in the form of a stem cell transplant. CAEBV is extremely rare in Western countries. Due to fatal complications early diagnosis is critical for successful treatment. Our case highlights the need for regular clinical re-evaluation and a comprehensive multispecialty approach in such cases.

  • ear
  • nose and throat/otolaryngology
  • immunology
  • haematology (incl blood transfusion)

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  • Contributors JW is the lead author. CBD is the coauthor. CPS is the coauthor and reviewed the manuscript. BH was the patient’s consultant and helped in review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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