Differential Diagnosis for 14 yo Female with Diffuse Ground Glass Opacities and Positive EBV
- Single most likely diagnosis
- Infectious Mononucleosis (IM) with Pulmonary Involvement: The presence of diffuse ground glass opacities, positive EBV, and a significant number of CD8+ cells on lung biopsy strongly suggests an EBV-related condition. IM can occasionally present with pulmonary findings, and the CD8+ cell predominance is consistent with a viral infection.
- Other Likely diagnoses
- Lymphoid Interstitial Pneumonia (LIP): This condition is associated with viral infections, including EBV, and can present with ground glass opacities on imaging. The presence of CD8+ cells and the lack of other pathogens support this diagnosis.
- Post-Infectious Pulmonary Disease: Some viral infections can lead to post-infectious pulmonary complications, including ground glass opacities. The recent EBV infection could be the trigger for such a condition.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Lymphoma: Although less likely, given the negative sarcoidosis and IgG4 results, lymphoma (especially lymphoproliferative disorders associated with EBV) must be considered due to its potential severity and the need for prompt treatment.
- Acute Respiratory Distress Syndrome (ARDS): While the clinical context does not strongly suggest ARDS, any condition leading to diffuse ground glass opacities can potentially progress to ARDS, which is life-threatening and requires immediate intervention.
- Rare diagnoses
- X-linked Lymphoproliferative Disease (XLP): This rare genetic disorder is characterized by an abnormal immune response to EBV, leading to severe illness. The presence of EBV and significant CD8+ response could suggest this condition, although it is rare and typically presents in males.
- Chronic Active EBV Infection (CAEBV): A rare condition where EBV infection persists and can lead to various complications, including pulmonary involvement. The diagnosis would require further investigation into the patient's EBV status and clinical course.