Clinical Pediatrics | 2021
Splenic Micro-Abscesses as a Complication of Epstein-Barr Virus
Abstract
A previously healthy 10-month-old male presented with a 1-month history of worsening bilateral anterior cervical lymphadenopathy and intermittent fevers. Two weeks prior to his visit to our hospital, he visited another emergency room where a respiratory viral polymerase chain reaction (PCR) panel was positive for rhinovirus/ enterovirus infection, and he was discharged home with instructions on supportive care for viral infections. In the week prior to admission, he had daily fever to 38.3 °C and decreased oral intake, prompting a reevaluation. On history, he had no recent travel, no known tick exposure, no sick contacts, was up to date on immunizations, and exhibited no other infectious symptoms such as cough, vomiting, diarrhea, or rash. The family had recently adopted a new puppy from a rescue shelter that was reportedly healthy and up to date on vaccines. His initial emergency room workup revealed a white blood cell count of 9.94 × 109/L and unremarkable differential, hemoglobin of 9.8 g/dL, and platelets of 245 000/μL. The peripheral smear demonstrated slight macrocytosis without anemia, left-shifted neutrophils with toxic granulation, and occasional reactive appearing lymphocytes. A complete metabolic panel was normal except for a mildly elevated aspartate aminotransferase to 73 units/L (reference range 17-64 units/L). A C-reactive protein measured 15.3 mg/L. A soft tissue neck ultrasound revealed diffuse bilateral enlarged lymph nodes, the largest measuring 2.3 cm × 1.5 cm × 2.6 cm, with no localized abscesses. On examination, he was afebrile, with a heart rate of 133 beats/minute, respiratory rate of 30 breaths/minute, normotensive, and oxygen saturation of 100% on room air. He was ill-appearing but nontoxic and appropriately interactive. He was dehydrated with tacky mucous membranes but no redness, swelling, ulceration, or exudates were noted in his oropharynx. There was no conjunctivitis. Lungs were clear to auscultation in all fields, and he was breathing without distress. He was noted to have hepatomegaly and splenomegaly. His bilateral cervical lymphadenopathy was mobile, mildly tender, and without overlying skin changes. No other lymphadenopathy was noted. The infant was admitted due to his decreased oral intake and resultant dehydration and for further workup of his prolonged fever and lymphadenopathy.