Cytokine responses in a severe case of glandular fever treated successfully with foscarnet combined with prednisolone and intravenous immunoglobulin

J Med Virol. 2009 Jan;81(1):99-105. doi: 10.1002/jmv.21383.

Abstract

Viral loads and cytokine responses Epstein-Barr virus (EBV) were measured in an 18-year-old boy with severe glandular fever complicated by a mild anaemia, severe thrombocytopaenia and neutropaenia. Hepatosplenomegaly was detected by abdominal ultrasound in the presence of significant hepatitis. Cytokine testing demonstrated elevated cell-mediated Th1 (IFN-gamma, IL-12, sTNFR1, CXCL10, CXCL9 and CCL3) and humoral Th2 (IL-4) immune responses. Serum antibodies to EBV virus capsid antigen (VCA) IgM and IgG antibodies were detected, together with a raised EBV DNA level (up to about 70,000 DNA copies/mL) in the acute phase of the illness. This EBV DNA load decreased rapidly in response to treatment with a combination of foscarnet, intravenous immunoglobulin and prednisolone, and the boy's symptoms settled eventually after approximately 50 days of illness, following this combined antiviral and immune-modulating therapy. Detailed immunological, virological, haematological and biochemical laboratory parameters are presented to document this patient's severe EBV disease and eventual recovery.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Viral / blood
  • Antiviral Agents / therapeutic use
  • Cytokines / blood*
  • DNA, Viral / blood
  • Drug Therapy, Combination
  • Foscarnet / therapeutic use*
  • Herpesvirus 4, Human / isolation & purification
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin M / blood
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunologic Factors / therapeutic use
  • Infectious Mononucleosis / drug therapy*
  • Infectious Mononucleosis / immunology*
  • Male
  • Prednisolone / therapeutic use*
  • Viral Load

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Viral
  • Antiviral Agents
  • Cytokines
  • DNA, Viral
  • Immunoglobulin G
  • Immunoglobulin M
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Foscarnet
  • Prednisolone