title: An unusual presentation of a common infection.
abstract: A 40-year-old Ghanaian woman presented with fever and exanthema. She had anemia, leukopenia, increased erythrocyte sedimentation rate (ESR), creatinin kinase, lactate dehydrogenase (LDH), and liver enzymes. She was diagnosed with schistosomiasis and was cured with praziquantel. During the following years, she developed polymyositis, chronic nephritis, and life-threatening perimyocarditis. High numbers of Epstein-Barr virus (EBV)-encoded RNA copies were demonstrated in CD8+ T-lymphocytes from endomyocardial biopsies. There was no evidence of any underlying immunosuppression or an EBV-related malignancy. Chronic active EBV infection was diagnosed, a clinical picture not described in an adult African previously. Interestingly, among all therapy attempts, only rituximab was effective at stabilizing the disease.
authors.affiliation: Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany. Joachim.Richter@med.uni-duesseldorf.de
authors.forename: J
authors.initials: J
authors.lastname: Richter
authors.forename: L
authors.initials: L
authors.lastname: Quintanilla-Martinez
authors.forename: K
authors.initials: K
authors.lastname: Bienemann
authors.forename: T
authors.initials: T
authors.lastname: Zeus
authors.forename: U
authors.initials: U
authors.lastname: Germing
authors.forename: O
authors.initials: O
authors.lastname: Sander
authors.forename: R
authors.initials: R
authors.lastname: Kandolf
authors.forename: D
authors.initials: D
authors.lastname: Häussinger
authors.forename: K
authors.initials: K
authors.lastname: Klingel
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001799:Blood Sedimentation; D018414:CD8-Positive T-Lymphocytes / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology; D009393:Nephritis / Q000473:pathology; D011223:Praziquantel / Q000627:therapeutic use; D012367:RNA, Viral / Q000302:isolation & purification*; D000069283:Rituximab; D012552:Schistosomiasis / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D012367:RNA, Viral; D000069283:Rituximab; D011223:Praziquantel