Multiorgan Failure Associated with Epstein-Barr Viremia-An Elusive Diagnosis: A Case Series
Arun Agarwal *
Department of Internal Medicine, Narayana Multispeciality Hospital, Jaipur, Rajasthan, India.
Mudit Agarwal
All India Institute of Medical Sciences, New Delhi, India.
Anudeep Saxena
Department of Critical Care Medicine, Narayana Multispeciality Hospital, Jaipur, Rajasthan, India.
Sheel Bhadra Jain
Department of Nephrology, Narayana Multispeciality Hospital, Jaipur, Rajasthan, India.
*Author to whom correspondence should be addressed.
Abstract
Fulminant Epstein Barr Virus (EBV), also known as (herpes simplex virus-4(HSV-4) induced multiple organ failure is rarely reported and should be considered a potential diagnosis in patients with multiple organ failure. From a clinical perspective, it should be remembered that fulminant herpes simplex Virus (HSV) infection may masquerade as “routine” bacterial severe sepsis/septic shock. This potentially fatal condition should be diagnosed early and treated. Here we describe three cases who were admitted with multi organ dysfunction and two of them finally deceasing in a septic shock with multi organ failure. No bacterial or fungal infection could be detected in one of these cases and were adequately treated in other two cases. The presence of EBV (HSV-4) was detected in plasma confirming EBV viremia. The presentation, clinical course and management are discussed.
Keywords: Epstein barr virus, human herpes virus-4 (HHV-4), multi organ failure, sepsis, immunocompetent.