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Epstein-Barr virus reactivation induced myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis
  1. Timothy Philip Noonan1,
  2. Konstantin N Konstantinov2 and
  3. Leonor Echevarria2
  1. 1Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
  2. 2New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Timothy Philip Noonan; tnoonan.do{at}gmail.com

Abstract

We present a patient with systemic symptoms including 4 months of dyspnoea worsened with exertion, fatigue, rhinorrhoea, intermittent facial swelling, generalised lymphadenopathy and weight loss. Laboratory studies demonstrated proteinuria and eosinophilia. His serology was consistent with Epstein-Barr Virus (EBV) reactivation. A lymph node biopsy was consistent with EBV-associated reactive lymphoid hyperplasia. He was told to continue symptomatic treatment for EBV infection. After several admissions, vasculitis workup and myeloperoxidase-antineutrophil cytoplasmic autoantibody (ANCA) studies were positive. Evolution of clinical symptoms, laboratory parameters and our literature review suggested the diagnosis of EBV-associated ANCA vasculitis. Steroids were started after the patient continued to deteriorate; the viral load started increasing, so we added valganciclovir with favourable clinical response and no relapse during the follow-up for 6 months. This suggests that with evidence of viraemia (primary or reactivation), antiviral treatment likely has clinical benefit while immunosuppression is being considered.

  • infectious diseases
  • proteinurea
  • vasculitis
  • infections

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Footnotes

  • Contributors LE first presented the idea to write this case report. TPN, KNK and LE all contributed to the writing and editing of this case report.

  • 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.

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

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