title: Early diagnosis and follow-up of chronic active Epstein-Barr-virus-associated cardiovascular complications with cardiovascular magnetic resonance imaging: A case report.
abstract: BACKGROUND
  Chronic active Epstein-Barr virus (EBV) infection (CAEBV) is characterized as chronic or recurrent mononucleosis-like symptoms and elevated EBV deoxyribonucleic acid (EBV-DNA) copies. Cardiovascular complications have high morbidity and mortality. The treatment regimen for CAEBV has not been established yet, resulting in poor prognoses. Herein, we present a case of cardiovascular magnetic resonance imaging (CMRI) evaluation with a series of sequences for CAEBV-associated cardiovascular involvement, which has never been reported.
  
  
  METHODS
  A 16-year-old female (body weight, 55 kg) developed a persistent fever and a positive EBV-DNA level of 28,000 copies/mL. Computed tomography angiography (CTA) showed aneurysms involving the aorta and its major branches, as well as multiple aneurysms and stenoses of the coronary arteries. CMRI of the coronary arteries depicted the dilution and stenosis of the arterial lumen as well as the thickening of the arterial wall. Late gadolinium enhancement (LGE) showed subendocardial and transmural delayed enhancement of the left ventricle, suggesting myocardial infarction.CAEBV and associated cardiovascular complications were diagnosed. After treatment with Medrol and Leflunomide, the clinical manifestation and serological parameters reversed to normal. However, the EBV-DNA level increased again to 13,900 copies/mL 2 months later. A follow-up with aorta CTA showed that the arterial walls of the bilateral common iliac artery aneurysms were thicker with new-onset mural thrombi. The aorta CTA also showed new-onset occlusion of the right coronary artery, but a follow-up of CMRI at the same day did not find new-onset delayed enhancement lesion.
  
  
  CONCLUSIONS
  This case reminds clinicians of the vital importance of early diagnosis and close follow-up of CAEBV-associated cardiovascular complications. With cine imaging, coronary artery imaging, LGE imaging, and other novel techniques, CMRI can effectively and comprehensively reveal the early and dynamic changes, and act as an important tool in the field of cardiovascular diseases.
authors: Department of Radiology Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College MR Collaborations NE Asia, Siemens Healthcare, Beijing, China.
authors: Shu
authors: S
authors: Jiang
authors: Xiao
authors: X
authors: Li
authors: Jian
authors: J
authors: Cao
authors: Di
authors: D
authors: Wu
authors: Lingyan
authors: L
authors: Kong
authors: Lu
authors: L
authors: Lin
authors: Zhengyu
authors: Z
authors: Jin
authors: Jing
authors: J
authors: An
authors: Yining
authors: Y
authors: Wang
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000821:virology; D002908:Chronic Disease; D000072226:Computed Tomography Angiography / Q000379:methods*; D042241:Early Diagnosis; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D064847:Multimodal Imaging; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors