Journal List > Korean J Gastroenterol > v.67(1) > 1007528

Korean J Gastroenterol. 2016 Jan;67(1):39-43. Korean.
Published online Jan 26, 2016.
Copyright © 2016 The Korean Society of Gastroenterology
A Case of Severe Chronic Active Epstein-Barr Virus Infection with Aplastic Anemia and Hepatitis
Ja In Lee, Sung Won Lee, Nam Ik Han, Sang Mi Ro, Yong-Sun Noh, Jeong Won Jang, Si Hyun Bae, Jong Young Choi and Seung Kew Yoon
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence to: Sung Won Lee, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul 06591, Korea. Tel: +82-32-340-7244, Fax: +82-2-599-3589, Email:
Received July 08, 2015; Revised August 15, 2015; Accepted August 18, 2015.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Epstein-Barr virus (EBV) causes various acute and chronic diseases. Chronic active EBV infection (CAEBV) is characterized by infectious mononucleosis-like symptoms that persist for more than 6 months with high viral loads in peripheral blood and/or an unusual pattern of anti-EBV antibodies. Severe CAEBV is associated with poor prognosis with severe symptoms, an extremely high EBV-related antibody titer, and hematologic complications that often include hemophagocytic lymphohistiocytosis. However, CAEBV which led to the development of aplastic anemia (AA) has not been reported yet. A 73-year-old woman was admitted to our hospital with intermittent fever, general weakness and elevated liver enzymes. In the serologic test, EBV-related antibody titer was elevated, and real-time quantitative-PCR in peripheral blood showed viral loads exceeding 104 copies/µg DNA. Liver biopsy showed characteristic histopathological changes of EBV hepatitis and in situ hybridization with EBV-encoded RNA-1 was positive for EBV. Pancytopenia was detected in peripheral blood, and the bone marrow aspiration biopsy showed hypocellularity with replacement by adipocytes. AA progressed and the patient was treated with prednisolone but deceased 8 months after the diagnosis due to multiple organ failure and opportunistic infection. Herein, we report a rare case of severe CAEBV in an adult patient accompanied by AA and persistent hepatitis.

Keywords: Epstein-Barr virus infections; Human herpesvirus 4; Hepatitis; Aplastic anemia


Fig. 1
Histologic findings of liver biopsy specimen. Destruction of limiting plate of hepatocytes by infiltrating lymphocytes at the lobular-portal-interface, a characteristic finding of piecemeal necrosis, is demonstrated (H&E, ×400).
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Fig. 2
Epstein-Barr virus in situ. Sinusoidal lymphocytes (arrows) are positive by in situ hybridization (×400).
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Table 1
Diagnostic Criteria for Severe Chronic Epstein-Barr Virus (EBV) Infection
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Financial support:None.

Conflict of interest:None.

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