Chronic active Epstein-Barr virus infection complicated with coronary aneurysm in 4 pediatric cases and the literature review

Abstract

Objective To enhance the recognition of cardiovascular complications associated with chronic active Epstein-Barr virus infection (CAEBV) in children. Methods In this study, the medical records of 4 pediatric patients with CAEBV complicated with cardiovascular impairment (coronary artery lesion and artery aneurysms) at Guangzhou Women and Children′s Medical Center, Guangzhou Medical University were evaluated and the literatures were reviewed. Results (1)Apart from complicated with coronary aneurysm, these patients exhibited intermittent fever, hepatomegaly, splenomegaly, lymphadenectasis, liver dysfunction and pleural effusion.The main complications including abdominal aortic dilation, interstitial pneumonia, uveitis and hemophagocytic syndrome were also observed.(2) Epstein-Barr virus-related antibody detected by immunofluorescence assays showed that all patients were Epstein-Barr virus IgG antibodies positive against viral capsid antigen and against nuclear antigen, with anti-early antigens IgG positive in 3 patients.The plasma Epstein-Barr virus DNA level in those patients with CAEBV ranged from 1.46×107 to 3.72×1010 copies/L at diagnosis.(3)The inspection of immunological aspects showed that serum IgG levels and CD4+ T cells increased in 4 patients, but the number of natural killer cells decreased in 3 patients with CAEBV at diagnosis. Conclusions (1) The children with CAEBV could lead to cardiovascular impairment included coronary aneurysm and other artery aneurysms.(2) At present, it is difficult to justify whether Epstein-Barr virus contributed to the development of coronary artery lesions or Kawasaki disease complicated by coronary aneurysm because histopathologic examination could not be executed in living body.Differential diagnosis only depends on clinical symptom and follow-up.(3)The study reminds clinicians of the vital importance of early diagnosis and close follow-up of CAEBV-asso-ciated cardiovascular complications through echocardiography, imaging procedures such as CT and other novel techniques.Meanwhile, the relevant inspections of Epstein-Barr virus should be carried out when coronary aneurysm is found in children. Key words: Chronic active Epstein-Barr virus infection; Cardiovascular damage; Coronary aneurysm; Child