Epstein-Barr virus infection triggers severe ITP in woman, 18: Report
Heavy menstrual bleeding was among first signs of acute EBV infection
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An Epstein-Barr virus (EBV) infection — prevalent and spread through bodily fluids — triggered severe immune thrombocytopenia (ITP) and heavy menstrual bleeding in a young woman in Portugal, according to a case report.
Clinicians used corticosteroids (anti-inflammatory and immunosuppressive medications) and iron supplements, which normalize blood parameters, to treat the underlying infection and the resulting ITP. The young woman experienced a complete clinical recovery after two months, the researchers reported.
The team noted that low levels of platelets, blood fragments that help with blood clotting, can lead to thrombocytopenia and cause heavy bleeding symptoms among individuals with the blood disorder.
“This case illustrates that severe, life-threatening thrombocytopenia can be the presenting feature of acute EBV infection,” the researchers wrote. “Understanding the specific immune mechanisms at play informs therapeutic choices and highlights the importance of monitoring for both acute resolution and potential long-term [complications].”
Their study, “Severe Immune Thrombocytopenic Purpura Associated With Acute Epstein–Barr Virus Infection: A Case Report,” was published in the journal Cureus.
ITP is an autoimmune bleeding disorder characterized by thrombocytopenia, with a patient’s low platelet levels increasing the risk of bleeding. The disease may be primary, when no underlying cause is identified, or secondary, as in this case, when an external factor, such as a viral infection, triggers the condition’s development.
EBV infection can promote immune system issues, lead to ITP
Infection with EBV, one of the most common human viruses worldwide, primarily manifests as fever, throat inflammation, and enlarged lymph nodes, which are immune organs. EBV infection can also potentially lead to liver and spleen enlargement. It also may lead to ITP by promoting immune dysregulation.
“ITP is a well-recognized … complication of acute EBV infection, particularly in children and young adults,” the researchers wrote. “Although EBV-associated ITP is often mild and self-limited, severe thrombocytopenia with clinically significant bleeding may occur.”
Here, a team of researchers from Unidade Local de Saúde São José in Lisbon described the case of an 18-year-old woman who developed severe ITP secondary to an acute EBV infection.
The woman sought emergency department treatment for lack of energy and painful swallowing for four days, which had not improved with anti-inflammatory and antibiotic therapies.
She also reported nose bleeding, generalized bruises, heavy menstrual bleeding lasting 10 days, and enlargement of lymph nodes in the neck region over the previous three weeks. A physical examination showed she also had a low fever, skin bleeding in the upper and lower limbs, and signs of throat inflammation.
Blood tests revealed severe thrombocytopenia and low levels of hemoglobin and iron — both of which are needed for red blood cells to carry oxygen through the body. The woman also had high levels of liver enzymes, which can indicate liver damage, and lactate dehydrogenase (LDH), suggestive of rapid cellular turnover. With that condition, the body is producing new cells to compensate for those being destroyed.
Clinicians also found elevated counts of lymphocytes, a type of immune cell that regulates immune responses, and low counts of neutrophils, immune cells that help the body fight infections.
Treatment led to full recovery for patient after 2 months
Further testing indicated the presence of antibodies consistent with an acute EBV infection, as well as an enlarged spleen, leading to a diagnosis of EBV-induced ITP.
The woman started treatment with oral prednisolone, a corticosteroid. She also received iron through a single intravenous, or into-the-vein, infusion, as iron deficiency related to prolonged menstrual bleeding was considered to be the main cause of her low hemoglobin levels, or anemia.
“During hospitalization, the patient exhibited progressive clinical and laboratory improvement, with recovery of platelet counts and resolution of [bleeding] manifestations,” the researchers wrote.
Early recognition, exclusion of alternative [causes], and timely initiation of appropriate therapy are essential to ensure a favorable prognosis [in EBV-induced ITP].
At the two-month follow-up, blood cell counts and hemoglobin levels had normalized, as did liver enzymes and LDH. Imaging also demonstrated a normalization of spleen volume.
The researchers noted that “early recognition, exclusion of alternative [causes], and timely initiation of appropriate therapy are essential to ensure a favorable prognosis” in patients with this condition.
“EBV-induced ITP should be considered in immunocompetent young patients presenting with acute severe thrombocytopenia, … bleeding, [swollen lymph nodes], and clinical features suggestive of [EBV infection],” the team wrote.
