Halabitska Iryna, Petakh Pavlo, Oksenych Valentyn, Kamyshnyi Oleksandr
Department of Therapy and Family Medicine, I. Horbachevsky Ternopil National Medical University, Voli Square, 1, 46001 Ternopil, Ukraine.
Department of Biochemistry and Pharmacology, Uzhhorod National University, 88000 Uzhhorod, Ukraine.
Pathogens. 2025 May 16;14(5):488. doi: 10.3390/pathogens14050488.
This case is unique in demonstrating the reactivation of latent tuberculosis (TB) following co-infection with SARS-CoV-2 and Epstein-Barr virus (EBV) in an otherwise healthy young adult. It highlights a rare clinical scenario in which viral immune dysregulation likely facilitated TB progression. To date, few reports have explored the complex interplay between COVID-19, EBV reactivation, and TB in a single patient, particularly with isolated extrapulmonary involvement. A 24-year-old woman presented with persistent low-grade fever, fatigue, night sweats, unintentional weight loss, and progressive cervical and supraclavicular lymphadenopathy. These symptoms emerged shortly after a moderate COVID-19 infection. Laboratory studies revealed elevated inflammatory markers and pronounced lymphopenia. EBV reactivation was confirmed via serology and PCR. Despite antiviral therapy, symptoms persisted, and imaging revealed necrotic lymphadenopathy. Tuberculous lymphadenitis was diagnosed through fine-needle aspiration cytology and PCR detection of . The patient was treated with a standard anti-tuberculosis regimen, resulting in clinical, radiological, and immunological improvement. This case underscores the importance of considering latent TB reactivation in patients with persistent lymphadenopathy and recent viral infections, particularly in regions with high TB prevalence. It also emphasizes the need for thorough immunological and microbiological assessment in complex post-viral syndromes. The main clinical takeaway is that COVID-19 and EBV co-infection may create a permissive environment for TB reactivation through immune system compromise.
该病例十分独特，展现了一名原本健康的年轻成年人在感染新型冠状病毒（SARS-CoV-2）和爱泼斯坦-巴尔病毒（EBV）后潜伏性结核病（TB）的重新激活。它突显了一种罕见的临床情况，即病毒免疫失调可能促使结核病进展。迄今为止，很少有报告探讨新冠肺炎、EBV重新激活和结核病在单一患者中的复杂相互作用，特别是在仅有肺外受累的情况下。一名24岁女性出现持续低热、疲劳、盗汗、体重意外减轻以及进行性颈部和锁骨上淋巴结病。这些症状在中度新冠肺炎感染后不久出现。实验室检查显示炎症标志物升高和明显的淋巴细胞减少。通过血清学和PCR确认了EBV重新激活。尽管进行了抗病毒治疗，症状仍持续存在，影像学显示坏死性淋巴结病。通过细针穿刺细胞学检查和PCR检测诊断为结核性淋巴结炎。该患者接受了标准抗结核治疗方案，临床、影像学和免疫学均有改善。 该病例强调了在患有持续性淋巴结病和近期病毒感染的患者中考虑潜伏性结核重新激活的重要性，特别是在结核病高发地区。它还强调了在复杂的病毒后综合征中进行全面免疫和微生物评估的必要性。主要临床要点是，新冠肺炎和EBV共同感染可能通过免疫系统受损为结核重新激活创造有利环境。
