Mayer H B, Wanke C A, Williams M, Crosson A W, Federman M, Hammer S M
Department of Medicine, Deaconess Hospital, Boston, Massachusetts 02215, USA.
Clin Infect Dis. 1996 Jun;22(6):1009-18. doi: 10.1093/clinids/22.6.1009.
Infectious mononucleosis, most commonly caused by Epstein-Barr virus (EBV), is generally a benign, self-limited illness. Occasionally, however, more severe complications may arise such as acute renal insufficiency. While subclinical renal involvement appears to be relatively common in patients with infectious mononucleosis, patients with significant renal parenchymal dysfunction have rarely been described in the English-language literature. In this report, we review 27 previous cases ad present a case of oliguric renal failure complicating heterophil-positive infectious mononucleosis. The patient required hemodialysis but recovered promptly with treatment with the combination of corticosteroids plus acyclovir. Renal biopsy revealed interstitial nephritis, and immunoperoxidase studies demonstrated a predominance of suppressor/cytotoxic T cells, which has been described in only one previous case report. In situ hybridization done on renal biopsy tissue failed to reveal evidence of EBV-encoded RNA-1. Acute renal failure in infectious mononucleosis is rare, often self-limited, and usually caused by interstitial nephritis that is likely the result of immunopathologic injury precipitated by EBV infection.
传染性单核细胞增多症大多由爱泼斯坦-巴尔病毒（EBV）引起，通常是一种良性的自限性疾病。然而，偶尔也可能出现更严重的并发症，如急性肾功能不全。虽然亚临床肾脏受累在传染性单核细胞增多症患者中似乎相对常见，但英文文献中很少描述有明显肾实质功能障碍的患者。在本报告中，我们回顾了之前的27例病例，并呈现了1例少尿性肾衰竭合并嗜异性抗体阳性传染性单核细胞增多症的病例。该患者需要进行血液透析，但通过皮质类固醇加阿昔洛韦联合治疗后迅速康复。肾活检显示为间质性肾炎，免疫过氧化物酶研究表明抑制性/细胞毒性T细胞占优势，此前仅有1例病例报告对此进行过描述。对肾活检组织进行的原位杂交未发现EBV编码RNA-1的证据。传染性单核细胞增多症所致的急性肾衰竭罕见，通常为自限性，且通常由间质性肾炎引起，间质性肾炎可能是EBV感染引发的免疫病理损伤的结果。
