Acyclovir as a Novel Treatment for Severe Chronic Active Epstein-Barr Virus

Abstract

Epstein-Barr virus (EBV) is a widely infectious pathogen affecting most of the global population at some point in their life. While, typically, primary infections are subclinical, chronic persistence of the virus due to T-cell proliferation can cause severe complications. Acute hepatitis due to chronic active EBV (CAEBV) has rarely been documented. This case details a previously healthy 81-year-old woman who presented with complaints of diffuse abdominal pain, nausea, and vomiting. Her diagnostic workup demonstrated an EBV infection with worsening thrombocytopenia, transaminitis, and hepatocellular liver injury with acute ascites. Her hospitalization was resistant to the traditional supportive treatment of EBV, requiring intensive care management and unorthodox therapy. Although antivirals have demonstrated limited utility in the treatment of CAEBV, the severity of her illness and refractory hospital course necessitated the use of acyclovir. She made a complete recovery with no deficits. The case demonstrates the presentation of acute hepatitis and ascites as a result of CAEBV, the clinical sequelae, and acyclovir as a potential new treatment option.

Keywords: antiviral therapy; chronic active epstein-barr virus (caebv); ebv hepatitis; epstein-barr virus; new therapy approaches; use of antibiotic; ‏acyclovir.

Figure 1. Computed tomography angiography of the abdomen/pelvis (coronal view). Radiologic impression was suggestive of diffuse, multifocal gastroenteric colitis with new ascites and heterogeneous hepatic perfusion.

Figure 2. CT without contrast of the abdomen/pelvis (transverse view). Radiologic impression read as residual moderate intra-abdominal ascites.

Figure 3. CT without contrast of the abdomen/pelvis (coronal view). Radiologic impression read as residual moderate intra-abdominal ascites.