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Case Reports
. 2023 Dec 7:16:7507-7513.
doi: 10.2147/IDR.S434929. eCollection 2023.

A Case of Adult Epstein-Barr Virus-Associated Pneumonia with Multiple Cavitary Pulmonary Lesions Confirmed by Lung Biopsy mNGS: A Case Report

Sanmei Zhuang #  1 , Xiaohong Yu #  1 , Yupeng Zhang #  1 , Xiaoyang Chen #  2
Affiliations
Case Reports

A Case of Adult Epstein-Barr Virus-Associated Pneumonia with Multiple Cavitary Pulmonary Lesions Confirmed by Lung Biopsy mNGS: A Case Report

Sanmei Zhuang et al. Infect Drug Resist. .

Abstract

Background: EBV pneumonia with multiple cavitary pulmonary lesions is clinically rare. We analyzed the clinical characteristics, diagnosis and treatment, with an aim to enhance clinicians' awareness of this disease and reduce misdiagnosis and missed diagnoses.

Case presentation: This paper presents A 59-year-old male patient's initial symptoms included fever, cough, sputum, and asthma. The pulmonary CT imaging demonstrated multiple patchy and ground glass consolidation in both lungs, partial cavitary formation, and subpleural mesh lattice changes in the lower lobe of both lungs. Further analysis, including bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) and CT-guided percutaneous lung biopsy mNGS, supported the diagnosis of EBV pneumonia. The patient was treated with acyclovir antiviral therapy for a week, resulting in symptom relief. Follow-up lung CT scans indicated interval reduction of inflammatory lesions, cavities, and interstitial changes. As the patient's condition improved significantly and he was discharged from hospital. The treatment was continued with oral acyclovir for 12 days. Subsequent outpatient follow-up CT performed 12 days after discharge revealed further improvement of the inflammatory lesions, as well as a reduction in cavitary and interstitial changes.

Conclusion: The clinical imaging findings in the presented case were highly distinctive and have not been documented in either domestic or international literature. This uniqueness could have potentially contributed to misdiagnosis or overlooked diagnosis. mNGS of percutaneous lung puncture tissue is valuable for the diagnosis of infection with rare lung pathogens.

Keywords: adult EBV pneumonia; diagnosis; imaging characteristics; metagenomic next-generation sequencing; treatment.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
CT Chest on April 11th, 2023 (multiple patchy solid and ground glass opacifications in both lungs, partial cavitary formation, and subpleural mesh lattice changes in the lower lobe of both lungs).
Figure 2
Figure 2
Pathology of the right upper lung biopsy (small amount of free alveolar epithelial and inflammatory exudation).
Figure 3
Figure 3
Detection of EBER in lung biopsy tissue, ISH (original magnification ×400, yellow arrow (brown puncta) indicates EBER signal located in the nucleus).
Figure 4
Figure 4
CT Chest on April 27th, 2023 (a decrease in bilateral lung consolidation, with some reduction in cavitary and interstitial changes compared with CT Chest on April 11th, 2023).
Figure 5
Figure 5
CT Chest on May 9th, 2023 (further improvement of the inflammatory lesions, more reduction in cavitary and interstitial changes compared with CT Chest on April 27th, 2023).
See this image and copyright information in PMC

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