Title: Haemolytic anaemia caused by Epstein-Barr virus infection in an adult, picked up in an urgent care setting.

Biography:

Dr Tom Jose has pursed his MBBS from Mahatma Gandhi University, India MRCEM in 2014, EBEEM in 2018 from Belgium, and currently working as associate specialist in A&E Royal Preston Teaching hospital, UK from 2018- till date.

Abstract

Introduction:
Infectious mononucleosis caused by Epstein-Barr virus is common in children characterised by fever, malaise, sore throat and lymphadenopathy. Autoimmune haemolytic anaemia is a rare complication of EBV infection occurring only in 1-3% of patients¹. Haemolysis should be considered in all patients with infectious mononucleosis who develop jaundice to avoid diagnostic delay and a deleterious outcome.
Aims and objectives:
We present an interesting case with autoimmune haemolytic anaemia as a complication of EBV infection, to increase its awareness and early diagnosis and treatment.
Key words:
Anaemia, jaundice, haemolysis, autoimmune, haemoglobin
Case report:
In this article, we present a 22-year-old previously fit and well gentle man, sent from army barracks to rule out jaundice as his colleagues noticed mild yellowish tinge to the face. He didn’t have any other symptoms. Examination revealed mild jaundice and pallor. There was no lymphadenopathy or hepatosplenomegaly. Laboratory investigations in the UCC showed a Hb of 65, and deranged liver functions.  Inpatient investigations revealed reticulocytosis, raised LDH, and EBV serology consistent with recent Acute Epstein-Barr virus infection. It was concluded that he was having Coombs negative autoimmune haemolytic anaemia as a complication of EBV infection. His counts recovered spontaneously while in the hospital with negative parameters for haemolysis without starting any immunosuppressive therapy.
Discussion:
Infectious mononucleosis is caused by Epstein – Barr virus infection characterised by fever, sore throat, lymphadenopathy and atypical lymphocytes. EBV is considered an infrequent cause of autoimmune haemolytic anaemia (AIHA)². AIHA is caused by formation of IgM antibodies against the polysaccharide antigens of red blood cells, causing agglutination in low temperatures leading to complement activation and haemolysis⁵. Treatment consists of IV immunoglobulin and oral steroids⁴. In this particular case, blood counts improved spontaneously without needing immunosuppressive therapy.
Conclusion:
Autoimmune haemolytic anaemia should be considered in infectious mononucleosis patients presenting with anaemia, though it is a very rare complication⁸. Treatment with IV immunoglobulin and oral corticosteroid appear to be beneficial in these cases¹⁰.
Acknowledgements:
The authors would like to thank Mr Yogdutt Sharma, Medical director of GTD for his assistance with proof-reading and editing the article.
Conflicts of interest:
There are no conflicts of interest.

Author’s contributions:
All authors have critically reviewed and approved the final draft and are responsible for the content of the article.