title: Cytokine responses in a severe case of glandular fever treated successfully with foscarnet combined with prednisolone and intravenous immunoglobulin.
abstract: Viral loads and cytokine responses Epstein-Barr virus (EBV) were measured in an 18-year-old boy with severe glandular fever complicated by a mild anaemia, severe thrombocytopaenia and neutropaenia. Hepatosplenomegaly was detected by abdominal ultrasound in the presence of significant hepatitis. Cytokine testing demonstrated elevated cell-mediated Th1 (IFN-gamma, IL-12, sTNFR1, CXCL10, CXCL9 and CCL3) and humoral Th2 (IL-4) immune responses. Serum antibodies to EBV virus capsid antigen (VCA) IgM and IgG antibodies were detected, together with a raised EBV DNA level (up to about 70,000 DNA copies/mL) in the acute phase of the illness. This EBV DNA load decreased rapidly in response to treatment with a combination of foscarnet, intravenous immunoglobulin and prednisolone, and the boy's symptoms settled eventually after approximately 50 days of illness, following this combined antiviral and immune-modulating therapy. Detailed immunological, virological, haematological and biochemical laboratory parameters are presented to document this patient's severe EBV disease and eventual recovery.
authors.affiliation: Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
authors.forename: Christine
authors.initials: C
authors.lastname: Ma
authors.forename: Chun K
authors.initials: CK
authors.lastname: Wong
authors.forename: Bonnie C K
authors.initials: BC
authors.lastname: Wong
authors.forename: K C Allen
authors.initials: KC
authors.lastname: Chan
authors.forename: Samantha W M
authors.initials: SW
authors.lastname: Lun
authors.forename: Nelson
authors.initials: N
authors.lastname: Lee
authors.forename: Justin
authors.initials: J
authors.lastname: Wu
authors.forename: Clive S
authors.initials: CS
authors.lastname: Cockram
authors.forename: Paul K S
authors.initials: PK
authors.lastname: Chan
authors.forename: Julian W
authors.initials: JW
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood*; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination; D017245:Foscarnet / Q000627:therapeutic use*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use; D007244:Infectious Mononucleosis / Q000188:drug therapy* / Q000276:immunology*; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D019562:Viral Load
chemical_list: D000893:Anti-Inflammatory Agents; D000914:Antibodies, Viral; D000998:Antiviral Agents; D016207:Cytokines; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D017245:Foscarnet; D011239:Prednisolone