Acute Epstein-Barr virus pneumonitis in an immunocompetent host: a case report and literature review

Background: Epstein-Barr virus (EBV) is a double-stranded DNA virus and a member of the Herpesviridae family. Acute EBV infection in immunocompetent adults typically presents as infectious mononucleosis, which is characterised by fever, tonsillar enlargement and cervical lymphadenopathy. Here, we present an unusual case of primary EBV infection which was complicated by pneumonitis, a rare manifestation of the disease in immunocompetent individuals. Case report: A 20-year-old male university student with no significant medical history attended the emergency department with a one week history of fever, dry cough and shortness of breath. The patient had developed a sore throat one week prior which had been treated with phenoxymethylpenicillin V, and subsequently, doxycycline, neither of which improved his symptoms. On arrival, the patient was febrile, tachycardic and hypoxic, with mild cervical lymphadenopathy and bibasal lung crepitations. Admission blood results were significant for a lymphocytosis and raised C-reactive protein (CRP). Chest x-ray showed bilateral patchy consolidation and bronchial dilatation, more notable on the left. Computed tomography pulmonary angiogram (CTPA) showed bronchial wall thickening and florid solid and ground glass centrilobular nodularity and areas of nodular consolidation in keeping with infection. Sputum culture did not yield any significant growth and no respiratory viruses were detected by polymerase chain reaction of nose and throat swab. IgM and IgG antibodies against EBV viral capsid antigen (VCA) were both detected on serological testing, confirming the diagnosis of acute EBV infection. Results: The patient was commenced on oral prednisolone and discharged home 48 h later once no longer requiring supplemental oxygen. His recovery was complicated by another episode of EBV tonsillopharyngitis requiring a further course of oral steroid therapy. Conclusion: While rare, EBV should be considered as a potential cause of pneumonitis in immunocompetent patients where other, more common, infective causes have been considered and excluded.