Reactivation of Epstein–Barr virus in Aplastic Anemia: A clinical challenge

Abstract

Background: Acquired aplastic anemia is an unusual disease associated with pancytopenia characterized by hypocellular bone marrow. Aplastic anemia is an auto-immune disorder wherein patients would show a antithymocyte globulin (ATG)- induced hematological response after T-cell reduction. The combination of cyclosporine A and ATG as immunosuppressive therapy is considered as the standard treatment approach for patients with aplastic anemia. EBV infection in a patient with aplastic anemia is an unusual clinical presentation. Case Report: A 49-year-old Asian female presented to our hospital with dizziness and fatigue. The patient’s platelet count was extremely low. A hypocellular marrow with lymphocytosis was observed with the help of a bone marrow aspirate and biopsy. The patient was given cyclosporine and eltrombopag as a bridge to primary therapy, i.e. antithymocyte globulin (ATG)/allogenic transplant considering she had pancytopenia. The patient developed platelet refractoriness. Epstein-Barr virus polymerase chain reaction (PCR) was performed, considering the patient’s atypical presentation. As per the results, it was significantly positive with 2250 copies/ul. A diagnosis of aplastic anemia with EBV infection was made.

Keywords

• Aplastic anemia,Immunosuppression,Epstein-Barr virus infections

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