scholarly journals Heart failure enigma in young man: the acute onset of a frequently encountered condition with an unexpected cause

2020 ◽  
Vol 13 (1) ◽  
pp. e233190
Author(s):  
George Luis Leonor Lopez ◽  
Sandra Viviana Chaparro ◽  
Nicholas Brozzi ◽  
Amit Badiye
Keyword(s):  
Pericardial Effusion ◽  
Pulseless Electrical Activity ◽  
Acute Onset ◽  
Coxsackie Virus ◽  
Small Lesion ◽  
St Segment Elevation ◽  
Barr Virus ◽  
Concentric Hypertrophy ◽  
Epstein Barr ◽  
The Right

An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.

Histopathologic, Immunohistochemical Features and Profile of Viral Antigens in Patients with Myocarditis

2015 ◽  
Vol 1085 ◽  
pp. 447-452 ◽  
Author(s):  
Yuliya Rogovskaya ◽  
Roman Botalov ◽  
Vyacheslav Ryabov
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Interstitial Fibrosis ◽  
Morphological Changes ◽  
Parvovirus B19 ◽  
Consensus Definition ◽  
Barr Virus ◽  
Epstein Barr ◽  
Group 2 ◽  
The Right

We studied medical records and endomyocardial biopsies of patients with morphological confirmed lymphocytic myocarditis. The patients were divided into two groups: 1 - patients with arrhythmias; group 2 - patients with predominance syndrome heart failure. Morphological verification of myocarditis was based on World Heart Federation Consensus definition of Inflammatory Cardiomyopathy, 1997. Immunohistological study was performed to identify antigens of cardiotrophic viruses. We revealed some features in topic and character of morphological changes in depending on clinical scenario of myocarditis. In patients with chronic heart failure due to myocarditis revealed a high incidence of expression of LMP-antigen Epstein-Barr virus, the lack of expression of adenovirus antigens. Arrhythmic presentation of myocarditis was characterized by a high frequency of expression of enteroviral VP-1 antigen and the type 1 antigen herpes virus. We were not detected expression of the VP-2 antigen parvovirus B19. As a result the most severe inflammatory changes and interstitial fibrosis of intraventricular septum, widespread damage of myocytes the severe myocardial remodeling was found in patients with presentation of myocarditis by chronic heart failure. Interstitial fibrosis of the outflow tracts of the right ventricle, the low activity of inflammation and mild fibrotic changes were feature of arrhythmic scenario of myocarditis.

scholarly journals Epstein-Barr virus meningoencephalitis in a immunocompetent child

2021 ◽  
Author(s):  
Gustavo Carvalho Costa ◽  
Alicia Carolina Coraspe Gonçalves ◽  
Thayse Indira Bonadio Simões ◽  
Flavia Andrade Rocha Borrelli
Keyword(s):  
Epstein Barr Virus ◽  
Transverse Myelitis ◽  
Barr Virus ◽  
Level Of Consciousness ◽  
Midbrain Region ◽  
Left Caudate ◽  
Diagnostic Hypothesis ◽  
Dystonic Posture ◽  
Epstein Barr ◽  
The Right

Introduction: Meningoencephalitis caused by the Epstein-Barr virus (EBV) is a rare neurological entity, most often related to the latent reactivation of thevirus associated with immunosuppression. The clinic varies between encephalitis, meningitis, cerebellitis, neuritis and transverse myelitis. The prognosis is good, with 85% of patients returning to baseline levels. Case report: We attend to a 11-month-old male patient, proper neuropsychomotor development, with reports of fever and odynophagia, without improvement with antibiotic therapy. He had a focal epileptic seizure. Upon admission, he presented a new similar event, with control after use of diazepam and intravenous phenobarbital. At the neurological examination carried out after improving the level of consciousness, the patient was alert. He presented axial hypotonia, dystonic posture in flexion of the right upper limb, with preserved strength. He showed no meningeal signs. The cerebrospinal fluid revealed 61 mg/dL of glucose, 57 mg/dL of proteins and 65/mm³ of leukocytes (90% of lymphocytes). Acyclovir, ceftriaxone, and dexamethasone were started, with improvement. Magnetic resonance imaging revealed: FLAIR hyper signal injury, with diffusion restriction, in the left caudate nucleus, left lentiform and ipsilateral anterior midbrain region. Electroencephalogram with diffuse attenuation of baseline electrical activity. The main diagnostic hypothesis was meningoencephalitis secondary to EBV infection, with confirmatory PCR-DNA. Conclusion: The report illustrates the need for attention to a rare infectious etiology in atypical presentation of meningoencephalitis.

scholarly journals Primary Intraocular Lymphoma in a Patient with Bilateral Epstein-Barr Virus Panuveitis: A Case Report

2021 ◽  
Author(s):  
Seyedeh Maryam Hosseini ◽  
Mojtaba Abrishami ◽  
Elham Barashki ◽  
Ghodsieh Zamani
Keyword(s):  
B Cell ◽  
Epstein Barr Virus ◽  
Cell Lymphoma ◽  
Antiviral Treatment ◽  
B Cell Lymphoma ◽  
Intraocular Lymphoma ◽  
Primary Intraocular Lymphoma ◽  
Barr Virus ◽  
Epstein Barr ◽  
The Right

Abstract Purpose: Herein, we report a case of primary intraocular lymphoma (PIOL) with the first presentation of bilateral Epstein-Barr virus (EBV)-associated panuveitis and retinitis.Case presentation: A 69-year-old male was referred with a three-day history of blurred vision and pain and redness in his left eye following cataract surgery. Ophthalmic examination revealed panuveitis, vitritis, and necrotizing retinitis with retinal hemorrhage. A month later, the right eye was also involved. Initially, the clinical diagnosis of acute retinal necrosis was made based on clinical manifestation; however, the partial response to intravenous and intravitreal antiviral treatment in the left eye and involvement of the right eye resulted in further investigation of masquerade syndromes. Polymerase chain reaction-based analysis of vitreous sample was positive for EBV, and cytological evaluation was compatible with the diagnosis of B-cell lymphoma. A significant improvement was observed following serial intravitreal rituximab and methotrexate injections. The central nervous system and lungs were involved after 6 months, and the patient expired despite treatment with systemic chemotherapy. Conclusion: There may be an association between EBV panuveitis and primary intraocular B-cell lymphoma.

scholarly journals A new therapy in Epstein-Barr virus-associated lymphoproliferative disease: a case report and a revision of the literature

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Lingling Xu ◽  
Hongjun Ba ◽  
Hongrong Lin ◽  
Liangying Zhong ◽  
Suping Li ◽  
...  
Keyword(s):  
Virus Infection ◽  
Lymphoproliferative Disorder ◽  
Epstein Barr Virus ◽  
Internal Carotid ◽  
Lymphoproliferative Disease ◽  
Epstein Barr Virus Infection ◽  
Barr Virus ◽  
Epstein Barr ◽  
Barr Virus Infection ◽  
The Right

Abstract Background Systemic chronic active Epstein-Barr virus infection is an extremely rare childhood disease. Since chronic active Epstein-Barr virus infection can trigger the onset of Epstein-Barr virus-associated lymphoproliferative disease. The clinical manifestations of the disease vary according to the site of involvement; therefore, management may be challenging. Currently, there are no standardized guidelines for treating Chronic active Epstein-Barr virus infection effectively. Case presentation We report a case of chronic active Epstein-Barr virus infection in a 5-year-old Chinese boy with intestinal, vascular, and neurological involvement. At age of 2 years and 7 months old, he had hepatomegaly and been diagnosed with Epstein-Barr virus infection. After treatment, he showed some clinical improvement. At age of 3 years and 3 months old, he presented with recurrent fever and diarrhea. Then he received methylprednisolone for 1 year and his symptoms ameliorated. At the age of 5 years, his symptoms recurred and had gastrointestinal hemorrhage and developed polyuria, frequent convulsions and hyponatremia. He was transferred to our hospital for further management. He was unconscious on admission and was diagnosised Epstein-Barr virus-lymphoproliferative disorder, based on the results in situ hybridization of EBV-encoded miRNA in sigmoid colon. Three-dimensional CT angiography demonstrated an aneurysm in the right internal carotid artery. Abdominal CT showed dilatation of vessels in part of the intestinal wall. He was also diagnosised Epstein-Barr virus encephalitis based on the elevated Epstein-Barr virus antibody titers and presence of Epstein-Barr virus DNA in the Cerebrospinal Fluid. A repeated duodenal artery embolization and symptomatic therapy could not control the hemorrhage after admission. He subsequently received treatment with ganciclovir, glucocorticoid, thalidomide, and propranolol. Hemorrhage was controlled in 5 days; his symptoms improved. The fever did not recur and the CSF pressure was also normalized. A follow-up CT at 3 months after admission showed regression of the aneurysm in the right internal carotid artery and the vascular lesion in the duodenum. Discussion and conclusions A new treatment protocol including thalidomide and propranolol resulted in a marked improvement in his clinical symptoms, and shows promise as a novel and effective therapeutic approach for Chronic active Epstein-Barr virus infection-associated lymphoproliferative disorder.

Pericardial effusion and congestive heart failure in a horse with multicentric lymphoma

2018 ◽  
Vol 6 (3) ◽  
pp. e000631
Author(s):  
Laura Hargreaves ◽  
Lara Gosling ◽  
Jonathon J Dixon
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Pericardial Effusion ◽  
Acute Onset ◽  
Histological Evaluation ◽  
Renal Neoplasm ◽  
Abdominal Ultrasonography ◽  
Definition Of ◽  
The Right ◽  
Multicentric Lymphoma

A 20-year-old Warmblood mare was evaluated for acute-onset tachycardia and a one-week history of lethargy and ventral oedema. Haematology revealed leucocytosis with neutrophilia. Ultrasonographic examination revealed pericardial effusion and cardiac tamponade consistent with right-sided congestive heart failure. Abdominal ultrasonography demonstrated loss of definition of the right kidney and a structure adjacent to the kidney suggestive of a renal neoplasm. A tentative antemortem diagnosis of multicentric neoplasia, most likely lymphoma, was made. The horse was subjected to euthanasia due to a grave prognosis. Postmortem examination and histological evaluation were consistent with lymphoma, including infiltration of the cardiac muscle with neoplastic cells. Although lymphoma has been reported to affect the heart, congestive heart failure due to cardiac and pericardial neoplastic infiltration has not been previously reported as the presenting complaint. This case report describes the diagnostic approach to pericardial effusion and congestive heart failure in a mare with lymphoma.

scholarly journals Pure Lymphoepithelioma-Like Carcinoma Originating from the Urinary Bladder

2016 ◽  
Vol 9 (1) ◽  
pp. 188-194 ◽  
Author(s):  
Takashi Nagai ◽  
Taku Naiki ◽  
Noriyasu Kawai ◽  
Keitaro Iida ◽  
Toshiki Etani ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Undifferentiated Carcinoma ◽  
Bladder Tumors ◽  
Adc Value ◽  
Barr Virus ◽  
Apparent Diffusion ◽  
Adc Values ◽  
Epstein Barr ◽  
The Right

Lymphoepithelioma-like carcinoma of the urinary bladder (LELCB) is a rare variant of infiltrating urothelial carcinoma. We report a case of LELCB in a 43-year-old man. Ultrasonography and cystoscopy revealed two bladder tumors, one on the left side of the trigone and the other on the right side of the trigone. Transurethral resection of the bladder tumors was performed and pathological analysis revealed undifferentiated carcinoma. We therefore performed radical cystectomy and urinary diversion. Immunohistochemically the tumor cells were positive for cytokeratin, but negative for Epstein-Barr virus-encoded small RNA in situ hybridization as found for previous cases of LELCB. The final pathological diagnosis was a lymphoepithelioma-like variant of urothelial carcinoma with perivesical soft tissue invasion. For adjuvant systemic chemotherapy, three courses of cisplatin were administered. The patient subsequently became free of cancer 72 months postoperatively. Based on the literature, pure or predominant LELCB types show favorable prognoses due to their sensitivity to chemotherapy or radiotherapy. An analysis of the apparent diffusion coefficient (ADC) values of bladder tumors examined in our institution revealed that the ADC value measured for this LELCB was relatively low compared to conventional urothelial carcinomas. This suggests that measuring the ADC value of a lymphoepithelioma-like carcinoma prior to operation may be helpful in predicting LELCB.

Transverse myelitis caused by varicella-zoster

2021 ◽  
Vol 14 (8) ◽  
pp. e238078
Author(s):  
Anjely Pulparampil Sebastian ◽  
Arini Basu ◽  
Nandini Mitta ◽  
Dominic Benjamin
Keyword(s):  
Neurological Complication ◽  
Spastic Paraparesis ◽  
Transverse Myelitis ◽  
Acute Onset ◽  
Epstein Barr Virus Infection ◽  
Varicella Zoster ◽  
Barr Virus ◽  
Intravenous Acyclovir ◽  
Epstein Barr ◽  
Barr Virus Infection

Transverse myelitis is a rare neurological complication seen with varicella-zoster virus (VZV) infection, which is common among immunocompromised hosts. It can occur during the primary VZV infection or reactivation of latent infection. It is a complication that requires prompt diagnosis and treatment. The present case is that of a 28-year-old immunocompetent man, who presented with fever, rash and acute-onset spastic paraparesis with bladder involvement. Causes such as herpes simplex 1 and 2, cytomegalovirus, enterovirus and Epstein-Barr virus infection were ruled out. On evaluation, he was diagnosed with acute primary disseminated VZV infection with parainfectious transverse myelitis, based on positive cerebrospinal fluid multiplex PCR (PCR) and serum VZV IgM antibodies. He was treated with intravenous acyclovir and steroids, with which he improved significantly.

Sign in / Sign up

Export Citation Format

Share Document