From the Guidelines
Chronic active Epstein-Barr Virus (CAEBV) infection is a rare but serious condition characterized by persistent EBV symptoms lasting more than six months, with common symptoms including persistent fever, severe fatigue, enlarged lymph nodes, liver dysfunction, spleen enlargement, abnormal blood counts, and skin rashes, as noted in patients with CAEBV 1. The symptoms of CAEBV can be diverse and may include:
- Persistent or intermittent fever
- Lymphadenopathy
- Hepatosplenomegaly
- Recurrent or continuous debilitating fatigue
- Sore throat
- Lymph node tenderness and pain
- Headache
- Myalgia
- Arthralgia
- Hematological, digestive tract, neurological, pulmonary, ocular, dermal, and/or cardiovascular disorders, as reported in the study by Okano et al. 1. Some patients may develop complications like hemophagocytic lymphohistiocytosis (HLH), organ failure, or lymphoma, highlighting the importance of early diagnosis and intervention. Treatment typically involves a multifaceted approach, starting with antiviral medications like ganciclovir or valganciclovir, though their effectiveness is limited, as noted in the study by Okano et al. 1. Immunomodulatory therapies such as corticosteroids, cyclosporine, or rituximab may help control immune dysregulation, and for severe cases, hematopoietic stem cell transplantation (HSCT) is considered the only potentially curative option, with protocols typically involving chemotherapy conditioning followed by transplantation from a matched donor 1. Regular monitoring of viral load, organ function, and blood counts is essential throughout treatment, and treatment should be managed by specialists in infectious diseases, hematology, or immunology due to the complexity of the condition. Key considerations in the management of CAEBV include:
- Early diagnosis and intervention to prevent life-threatening complications
- Multifaceted treatment approach, including antiviral and immunomodulatory therapies
- Regular monitoring of viral load, organ function, and blood counts
- Consideration of HSCT for severe cases
- Management by specialists in infectious diseases, hematology, or immunology.
From the Research
Symptoms of Chronic Active EBV
- Chronic persistent or recurrent pyrexia (fever) 2
- Lymphadenopathy (enlarged lymph nodes) 2
- Hepatosplenomegaly (enlarged liver and spleen) 2
- Systemic inflammation and multiple organ failures caused by the invasion of infected cells 3
- Mononucleosis-like symptoms 2
- Severe hypercytokinemia and hemophagocytic syndrome, which may occur suddenly and result in a fatal clinical course 4
Treatment Options for Chronic Active EBV
- Allogeneic hematopoietic stem cell transplantation (HSCT) is the only cure for CAEBV, without which patients often die within several years 4, 5, 3
- Immunochemotherapy, including steroids, cyclosporine A, and etoposide, as part of a 3-step treatment strategy 4, 5
- Multi-drug block chemotherapy as part of a 3-step treatment strategy 5
- Adoptive transfer of EBV-specific cytotoxic T lymphocytes has shown promise as a treatment modality 6
- Etoposide-based regimens have shown promise as a treatment modality 6