Khine Su, Edupuganti Srujan, Upadhyay Manoj, Liroff Kaitlin
Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA.
Department of Internal Medicine-Pediatrics, Hurley Medical Center, Flint, Michigan, USA.
Eur J Case Rep Intern Med. 2023 Sep 5;10(10):004039. doi: 10.12890/2023_004039. eCollection 2023.
Infectious mononucleosis (IM), the most common presentation of acute Epstein Barr virus (EBV) infection, typically presents with fever, pharyngitis and lymphadenopathy. We describe an unusual case of IM presenting as acute sinusitis. A 25 year-old male presented to the emergency department with worsening right frontal sinus pain along with fever, chills, and greenish nasal discharge for 3 weeks. Laboratory workup showed leukocytosis with high lymphocyte counts as well as transaminitis. Facial computerized tomography (CT) showed extensive right frontal, ethmoidal and maxillary sinusitis and antrochoanal polyp. The patient underwent endoscopy with drainage of purulent material and polyp removal. Unfortunately, cultures of the sample were not sent and bacterial infection could not be ruled out. Broad spectrum antibiotics were continued. Pathology of redundant tissue revealed large atypical lymphocytes with positive EBV-encoded RNA and lack of evidence of extranodal natural killer/T-cell (NK/T-cell) type lymphoma (ENKTCL). Tests for serum EBV IgM antibodies and EBV early Antigen antibodies were positive, indicating acute EBV infection. Lymphocytosis resolved along with significant clinical improvement at the 10-day follow up visit. Even though patient did receive antibiotics, multiple factors including isolated lymphocytosis, pathology positive for EBV with no neutrophilia were more suggestive of sinusitis caused by viral infection, EBV in this case. Lymphocytosis with fever and sore throat should prompt physicians to consider IM. There are no known reports in the literature of EBV as a causal organism for acute viral sinusitis. There are some studies relating EBV with ENKTCL. It is unknown whether this particular patient with a history of EBV sinusitis will be at high risk for nasal type lymphoma in the future. Further studies should be conducted to understand the pathogenesis and relationship between EBV and ENKTCL.
Infectious mononucleosis (IM) can present with various atypical presentations. Consideration of IM should not be limited to people presenting with a triad of fever, lymphadenopathy and sore throat. Lymphocytosis with atypical symptoms should raise suspicion of infectious mononucleosis.No case has been reported of EBV as a causal organism for acute sinusitis. Association with EBV infection and chronic sinusitis or nasal polyp or extranodal NK/T cell lymphoma has been demonstrated but pathogenesis is poorly understood.Studies should be done on whether acute sinusitis secondary to EBV poses a risk for nasal type lymphoma.
传染性单核细胞增多症（IM）是急性爱泼斯坦-巴尔病毒（EBV）感染最常见的表现形式，通常表现为发热、咽炎和淋巴结病。我们描述了一例表现为急性鼻窦炎的不寻常的IM病例。一名25岁男性因右额窦疼痛加重、发热、寒战和绿色鼻分泌物3周就诊于急诊科。实验室检查显示白细胞增多伴淋巴细胞计数升高以及转氨酶升高。面部计算机断层扫描（CT）显示广泛的右额窦、筛窦和上颌窦炎以及鼻窦后鼻孔息肉。患者接受了内镜检查，引流脓性物质并切除息肉。遗憾的是，未送检样本培养物，无法排除细菌感染。继续使用广谱抗生素。多余组织的病理检查显示大量非典型淋巴细胞，EBV编码RNA阳性，且无结外自然杀伤/T细胞（NK/T细胞）型淋巴瘤（ENKTCL）的证据。血清EBV IgM抗体和EBV早期抗原抗体检测呈阳性，表明为急性EBV感染。在10天的随访中，淋巴细胞增多症消失，临床症状显著改善。尽管患者确实接受了抗生素治疗，但包括孤立性淋巴细胞增多症、EBV病理检查阳性且无中性粒细胞增多等多种因素更提示为病毒感染（本例为EBV）引起的鼻窦炎。伴有发热和咽痛的淋巴细胞增多症应促使医生考虑IM。文献中尚无EBV作为急性病毒性鼻窦炎病原体的报道。有一些研究将EBV与ENKTCL相关联。尚不清楚这位有EBV鼻窦炎病史的特定患者未来是否会有患鼻型淋巴瘤的高风险。应进行进一步研究以了解EBV与ENKTCL之间的发病机制和关系。
传染性单核细胞增多症（IM）可表现为各种非典型形式。对IM的考虑不应局限于出现发热、淋巴结病和咽痛三联征的人群。伴有非典型症状的淋巴细胞增多症应引起对传染性单核细胞增多症的怀疑。尚无EBV作为急性鼻窦炎病原体的报道。已证实EBV感染与慢性鼻窦炎、鼻息肉或结外NK/T细胞淋巴瘤有关，但发病机制尚不清楚。应研究继发于EBV的急性鼻窦炎是否会增加患鼻型淋巴瘤的风险。
