title: Epstein-Barr viral load assessment in immunocompetent patients with fulminant infectious mononucleosis.
abstract: We describe 2 immunocompetent adolescents with fulminant infectious mononucleosis and virus-associated hemophagocytosis. A new quantitative polymerase chain reaction revealed high serum Epstein-Barr virus DNA levels in these patients. One patient died with an increasing viral load not responding to corticosteroids followed by antiviral and intensified immunomodulatory treatment. The other patient received corticosteroids and acyclovir at diagnosis; her rapid recovery was heralded by a steep decline of viral load. We propose monitoring the clinical course of fulminant infectious mononucleosis in immunocompetent patients by Epstein-Barr virus DNA quantification and prompt corticosteroid and antiviral therapy when viral load is high.
authors.affiliation: Department of Oncology, Groene Hilledijk 301, 3075 EA Rotterdam, the Netherlands. vanlaar@inw1.azr.nl
authors.forename: Jan A M
authors.initials: JA
authors.lastname: van Laar
authors.forename: Corinne M P
authors.initials: CM
authors.lastname: Buysse
authors.forename: Ann C T M
authors.initials: AC
authors.lastname: Vossen
authors.forename: Björn
authors.initials: B
authors.lastname: Hjálmarsson
authors.forename: Bart
authors.initials: B
authors.lastname: van Den Berg
authors.forename: Kirsten
authors.initials: K
authors.lastname: van Lom
authors.forename: Jaap
authors.initials: J
authors.lastname: Deinum
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007108:Immune Tolerance; D007244:Infectious Mononucleosis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D010198:Pancytopenia / Q000209:etiology; D016133:Polymerase Chain Reaction / Q000379:methods; D011239:Prednisolone / Q000627:therapeutic use; D019562:Viral Load
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D011239:Prednisolone; D000212:Acyclovir