Stefanou Christos, Tzortzi Christiana, Georgiou Fotini, Timiliotou Chrystalla
Limassol General Hospital, Limassol, Cyprus.
BMJ Case Rep. 2016 Dec 9;2016:bcr2016216488. doi: 10.1136/bcr-2016-216488.
Epstein-Barr virus (EBV)-related haemophagocytic lymphohistiocytosis (EBVr-HLH) has a better prognosis when the virus is rapidly cleared, but the best antiviral approach is controversial. We present a patient to whom the therapeutic standard rituximab was co-administered with valacyclovir and an HLH-specific treatment with favourable viral and clinical responses. We conducted an extensive literature review and contacted several world reference centres and experts to inquire about their approaches and experience. We conclude that antivirals are infrequently used for EBVr-HLH, despite their laboratory-proven and likely clinical beneficial effect on some EBV-related diseases. However, the role of antivirals remains obscure. Concerns about their lack of efficacy are based on observational data and reports of the cellular tropism of EBV. Therefore, the adjunct use of antivirals may be considered when myelotoxicity is not the primary concern, and related outcomes should be systematically recorded to produce higher quality evidence.
当病毒迅速清除时，爱泼斯坦-巴尔病毒（EBV）相关噬血细胞性淋巴组织细胞增生症（EBVr-HLH）的预后较好，但最佳抗病毒方法存在争议。我们报告了一名患者，对其同时给予了治疗标准药物利妥昔单抗和伐昔洛韦，并进行了HLH特异性治疗，病毒和临床反应良好。我们进行了广泛的文献综述，并联系了几个世界参考中心和专家，询问他们的治疗方法和经验。我们得出结论，尽管抗病毒药物在实验室已被证明对某些EBV相关疾病可能有临床益处，但在EBVr-HLH中很少使用。然而，抗病毒药物的作用仍不明确。对其缺乏疗效的担忧基于观察数据和EBV细胞嗜性的报告。因此，当骨髓毒性不是主要关注点时，可以考虑辅助使用抗病毒药物，并应系统记录相关结果以产生更高质量的证据。
