Vidarabine therapy for severe chronic active Epstein-Barr virus infection.
OBJECTIVE
Severe chronic active Epstein-Barr virus infection (SCAEBV) is an intractable disease with a poor prognosis, and a definitive treatment has not been established. We administered vidarabine to patients with natural killer (NK) cell-type SCAEBV and evaluated clinical and virologic effects.


METHODS
Four patients with SCAEBV were enrolled in this study. These patients had various symptoms, including fever, chronic hepatitis, hepatosplenomegaly, and hypersensitivity to mosquito bites. All patients had increased numbers of NK cells in their peripheral blood, and most of these were infected with EBV. Viral load was measured by in situ hybridization and quantitative polymerase chain reaction (PCR).


RESULTS
The patients all responded to the therapy, and their symptoms improved. After the therapy, the number of NK cells in their peripheral blood decreased. In two patients who were closely monitored, the viral load measured by in situ hybridization and quantitative PCR decreased in parallel with the symptomatic improvement. After discontinuing this drug, the patient's symptoms returned and the Epstein-Barr virus load increased again.


CONCLUSIONS
These results indicate that vidarabine therapy is a therapeutic choice to control SCAEBV, although its effect may be transient.
Kimura
H
H
Department of Pediatrics, Nagoya University School of Medicine, Japan. hkimura@med.nagoya-u.ac.jp
Morita
M
M
Tsuge
I
I
Hoshino
Y
Y
Tanaka
N
N
Ito
Y
Y
Morishima
T
T
D000293:Adolescent; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D000956:Antigens, Viral / Q000276:immunology; D000998:Antiviral Agents / Q000627:therapeutic use*; D036022:Capsid Proteins; D002648:Child; D002908:Chronic Disease; D002999:Clone Cells / Q000276:immunology / Q000473:pathology / Q000821:virology; D009033:Culicidae; D004341:Drug Evaluation; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy* / Q000276:immunology; D019309:Epstein-Barr Virus Nuclear Antigens / Q000276:immunology; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000502:physiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016130:Immunophenotyping; D007299:Insect Bites and Stings / Q000150:complications / Q000276:immunology; D007694:Killer Cells, Natural / Q000276:immunology / Q000473:pathology / Q000821:virology; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000276:immunology; D012008:Recurrence; D016896:Treatment Outcome; D014740:Vidarabine / Q000627:therapeutic use*; D019562:Viral Load; D014775:Virus Activation
D000914:Antibodies, Viral; D000956:Antigens, Viral; D000998:Antiviral Agents; D036022:Capsid Proteins; D019309:Epstein-Barr Virus Nuclear Antigens; C041788:Epstein-Barr viral capsid antigen; C099537:Epstein-Barr virus encoded RNA 1; D007074:Immunoglobulin G; D012367:RNA, Viral; D014740:Vidarabine; C417029:EBV-encoded nuclear antigen 1