PT  - JOURNAL ARTICLE
AU  - Timothy Philip Noonan
AU  - Konstantin N Konstantinov
AU  - Leonor Echevarria
TI  - Epstein-Barr virus reactivation induced myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis
AID  - 10.1136/bcr-2021-245059
DP  - 2021 Oct 01
TA  - BMJ Case Reports
PG  - e245059
VI  - 14
IP  - 10
4099  - http://casereports.bmj.com/content/14/10/e245059.short
4100  - http://casereports.bmj.com/content/14/10/e245059.full
SO  - BMJ Case Reports2021 Oct 01; 14
AB  - 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.