Epstein-Barr Virus-Induced Infectious Mononucleosis Complicated by Acute Renal Failure: Case Report and Review

Infectious mononucleosis, most commonly caused by Epstein-Barr virus (EBV), is generally a benign, self-limited illness. Occasionally, however, more severe complications may arise such as acute renal insufficiency. While subclinical renal involvement appears to be relatively common in patients with...

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Bibliographic Details
Published in:Clinical infectious diseases 1996-06, Vol.22 (6), p.1009-1018
Main Authors: Mayer, Howard B., Wanke, Christine A., Williams, Mark, Crosson, Ann W., Federman, Micheline, Hammer, Scott M.
Format: Article
Language:English
Subjects:
Acute Kidney Injury - complications
Acute Kidney Injury - diagnosis
Acute Kidney Injury - pathology
Acute Kidney Injury - therapy
Adult
Antibodies
Biological and medical sciences
Biopsies
Biopsy
Clinical Articles
Epstein Barr virus infections
Epstein-Barr virus
Herpesvirus 4, Human - isolation & purification
Heterophils
Human viral diseases
Humans
Infectious diseases
Infectious mononucleosis
Infectious Mononucleosis - complications
Infectious Mononucleosis - diagnosis
Infectious Mononucleosis - therapy
Interstitial nephritis
Kidney - pathology
Kidneys
Male
Medical sciences
Nephritis, Interstitial - complications
Nephritis, Interstitial - immunology
Proteinuria
T lymphocytes
T-Lymphocytes, Regulatory - immunology
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Description
Summary:Infectious mononucleosis, most commonly caused by Epstein-Barr virus (EBV), is generally a benign, self-limited illness. Occasionally, however, more severe complications may arise such as acute renal insufficiency. While subclinical renal involvement appears to be relatively common in patients with infectious mononucleosis, patients with significant renal parenchymal dysfunction have rarely been described in the English-language literature. In this report, we review 27 previous cases and present a case of oliguric renal failure complicating heterophil-positive infectious mononucleosis. The patient required hemodialysis but recovered promptly with treatment with the combination of corticosteroids plus acyclovir. Renal biopsy revealed interstitial nephritis, and immunoperoxidase studies demonstrated a predominance of suppressor/cytotoxic T cells, which has been described in only one previous case report. In situ hybridization done on renal biopsy tissue failed to reveal evidence of EBV-encoded RNA-l. Acute renal failure in infectious mononucleosis is rare, often self-limited, and usually caused by interstitial nephritis that is likely the result ofimmunopathologic injury precipitated by EBV infection.
ISSN:1058-4838
1537-6591
DOI:10.1093/clinids/22.6.1009