title: Epstein-Barr Virus Associated Hemophagocytic Syndrome after Scrub Typhus Infection.
abstract: There have been a small number of cases of scrub typhus-associated hemophagocytic syndrome (HPS), most of which were treated successfully using adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV)-associated HPS after scrub typhus infection that was not improved using antirickettsial treatment. A 73-year-old male who had been diagnosed with scrub typhus according to an eschar and a positive serology was transferred to our institution because of a persistent fever despite 7-day doxycycline therapy. Physical and laboratory data showed hepatosplenomegaly, bicytopenia, hyperferritinemia, and hypofibrinogenemia. A bone marrow examination (BM) revealed hypercellular marrow with hemophagocytosis and histiocyte infiltration. EBV was detected in BM aspirates using polymerase chain reaction. After a diagnosis of HPS was made, the patient was treated successfully using high-dose steroids.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jeong Woo
authors.identifier: http://orcid.org/0000-0001-8744-9772
authors.initials: JW
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Hyun Seon
authors.initials: HS
authors.lastname: You
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Jo
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Suh
authors.affiliation: Division of Infectious Diseases, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: In Gyu
authors.initials: IG
authors.lastname: Bae
authors.affiliation: Division of Infectious Diseases, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. zenmd@naver.com.
authors.forename: Oh Hyun
authors.identifier: http://orcid.org/0000-0002-4630-1242
authors.initials: OH
authors.lastname: Cho
keywords: Epstein-Barr virus infections; Lymphohistiocytosis, Hemophagocytic; Scrub typhus