Agranulocytosis due to Ebstein-Barr Virus (EBV) infection

Abstract

          Agranulocytosis is defined by the state of neutrophil less than 500/mm³. It has been rarely diagnosed but it can be fatal if it is notimmediately recognized and treated.Its common cause is mainly drugs especially anti-thyroid drug. Agranulocytosis due to infections e.g., Epstein-Barr virus (orEBV) has been occasionally reported. Herein, we studied a 3-year-old Thai boy who firstly presented with acute febrile illness, no organ specific symptom. The physical examination revealed only fever while the blood tests showed normal white blood cell (WBC) count but positive for anti-EBV (VCA) IgM. With symptomatic treatment, he could be discharged home within three days. Twenty-six days later, he again suddenly developed acute fever without chill, no organ specific symptom. Besides fever, lymphadenopathy and hepatosplenomegaly were not found on the physical examination. The CBC was studied again, Hb 11.3 g%, Hct 33.5 %, WBC 2,350/mm³, N 3 %, L 96 %, platelet 256,000/mm³, absolute neutrophil count 70.5/mm³. The bone marrow study revealed the normocellularity, with increased histiocytesand evidence of hemophagocytic cells but no hematologic malignancies by the flow cytometry. Two specimens of blood culture for bacteria yielded no growth. He was diagnosed as agranulocytosis possibly related to previous EBV infection. And he was treated with combined antibiotics without colony stimulating factors. He could recover and could be discharged on the 8^th day of admission. He has been followed every 6 months for physical examination and CBC for nearly all ten years. He is still healthy without agranulocytosis, Burkitt’s lymphoma or nasopharyngeal carcinoma.