PROFOUND NEUTROPENIA AS A SEQUELA OF PRIMARY EBV INFECTION T. Dao MD, C. Wexler MD, J. Coe MD, N. Sells MD Internal Medicine Residency Program, University Hospital and Clinics, LSUHSC, Lafayette, LA INTRODUCTION: Infectiousmononucleosis commonly presents as fever, pharyngitis, and cervical lymphadenopathy that is often self-limited. It can be caused by many pathogens, most notably Epstein-Barr virus, and is transmitted through oral contact. Although a reactive lymphocytosis is typically seen, a mild relative and absolute neutropenia may be seen in some patients. However, profound neutropenia defined as an absolute neutrophil count less than 100/mm 3 is not a well-documented sequela of primary EBV infection in immunocompetent hosts. CASE: 54-year-old woman with no past medical history presented after bloodwork ordered by her primary care physician showed a leukocyte count of 700. The patient had sought care after a two-month history of recurrent fevers (Tmax 103 o F) which were refractory to both acetaminophen and ibuprofen. She denied new medications, travel history, or sick contacts. She appeared clinically stable with unremarkable vital signs. Her WBC was found to be 700 with an absolute neutrophil count of 10. Hemoglobin and hematocrit were 9.9/29.7. Platelet count was 82,000. Erythrocyte sedimentation rate was 68. A diagnostic workup was initiated to exclude other causes of her pancytopenia with profound neutropenia. A flow cytometry was done which was negative for malignancy or lymphoproliferative disorders. A viral workup including parvovirus B19, Hepatitis panel, CMV, HIV, HSV, and HTLV I and II were negative for acute infection. PCR for EBV DNA was positive as well as viral capsid antigen (VCA) IgG but IgM was negative. Bone marrow analysis was negative for dysplasia, MDS, or lymphoma. Her blood cultures fromadmissionwere negative. Throughout her hospital course, she remained afebrile and her leukocyte count steadily improved. At the time of discharge, her leukocyte count was 1,400, with an absolute neutrophil count of 200. She was discharged with a plan to follow up with her primary care physician. DISCUSSION: This case discusses an uncommon hematologic finding in infectious mononucleosis. Although a mild neutropenia can be seen in early stages of the infection, profound neutropenia as seen in this case is uncommon in an otherwise healthy patient.
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