engleski

Post-COVID-19 syndrome associated with Epstein-Barr virus (EBV) reactivation - a case report

Introduction/Objectives: Between 10-60 % of survivors who had mild/moderate COVID 19 present symptoms of post-COVID-19 syndrome for 12 weeks or more. It is heterogeneus condition that includes sequelae in multiple organs, although post-viral chronic fatigue syndrome and neurocognitive disorders predominate. SARS-CoV-2 infection is associated with increased levels of proinflammatory cytokines and systemic inflammation. Pathological mechanism of many post- COVID-19 symptoms is results of abnormal or excessive autoimune and inflammatory response as well as a possible reactivation of latent herpesviruses (EBV, CMV). Objectives: Review of clinical presentation of patient with post-COVID- 19 syndrome and EBV reactivation. Participants, Materials/Methods: The assessment of the severity of COVID- 19 disease was determined according to the quidelines of the Ministry of Health. Covid-19 was confirmed by positive RT PCR from a nasopharyngeal swab, and antibodies to EBV were detected using chemiluminescence immunoassay (CLIA). A 37-year-old previously healthy female, presented with moderate COVID 19 pneumonia but did not required supplemental oxygen and hospitalization. Following the resolution of acute dissease she experienced post- COVID- 19 symptoms: chest pain, shortness of breath, palpitations, new onset hypertension, insomnia, headache, myalgia, arthralgiae, fever, anxiety/depression, extreme fatigue, sleep disturbance, brain fog/ memory impairment. The symptoms were partially reduced after eight –months of follow-up. Results: Physical examinatoin was unremarkable. Initial laboratory abnormalities included leukocytosis (16x109/L) with neutrophilia (83%) and lymphopenia (11%) and elevated inflammatory markers (CRP 35mg/L, ferritin 250 uq/L). Lung function tests (spirometry, DLCO, MSCT pulmonary angiography), non-invasive cardiac and neurological examination were without patological finding. Cerebrospinal fluid analysis, autoimmune antibody testing (Anti-AChR antibodies, anti MuSK antibodies, anti-GAD antibodies), Quantiferon test, thyroid function panel, electromyography, MRI of the brain and cervical spine, Carotid and vertebral arteries Color Doppler and transcranial color Doppler and scintigraphy bone scan were unremarkable. Electroencephalogram showed a mild dysrhythmias in frontotemporal reion. Serology was confirmed EBV reactivation -VCA IgM- 28 positive, IgG positive -649, EA IgG negative, EBNA IgG positive >600. Lymphocyte subpopulation count were determined by flow cytometry was confirmed activation of cellular immunity: CD3 T lymphocytes : 2198 (range 536-1787), CD3+CD4+ T cells: 1717 (range 309-1139). Psychological tests detected neurocognitive deficits: memory disorders, reduced verbal fluency. Conclusions: We reported a case of post- COVID-19 syndrome manifesting with persistent physical and neuropsychiatric symptoms which may be the results of prolonged systemic COVID- 19 inflammation- induced EBV reactivation.

post-COVID-19 syndrome ; EBV reactivation

nije evidentirano