{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T15:40:09Z","timestamp":1745768409422,"version":"3.40.4"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 20-year-old woman presented with a 2-week history of fever and malaise. Physical examination was unremarkable. Viral infection was suspected and Epstein\u2013Barr virus serology confirmed acute infectious mononucleosis. During admission, she gradually developed pancytopenia and liver enzyme abnormalities. The patient clinically deteriorated with persisting fever, orthostatic hypotension and hepatosplenomegaly. Bone marrow examination showed haemophagocytic lymphohistiocytosis (HLH). Treatment with high-dose corticosteroids was started and patient recovered quickly. Ferritin decreased immediately, fever resolved within 3 days, viral clearance was reached within 3 weeks. Steroid therapy was gradually tapered off in three months. The Histiocyte Society recommends immunochemotherapy with steroids, etoposide and cyclosporine. Potential side effects of etoposide are severe bone marrow depression and leukaemia. Our patient survived on corticosteroids alone. Early recognition of HLH and prompt treatment are of utmost importance for survival. Treatment with steroids alone can be life-saving.<\/jats:p>","DOI":"10.1136\/bcr.08.2011.4643","type":"journal-article","created":{"date-parts":[[2011,10,28]],"date-time":"2011-10-28T15:24:53Z","timestamp":1319815493000},"page":"bcr0820114643","source":"Crossref","is-referenced-by-count":0,"title":["Overwhelming primary Epstein\u2013Barr virus infection requiring corticosteroid treatment"],"prefix":"10.1136","volume":"2011","author":[{"given":"Marije Gordinou","family":"de Gouberville","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martien","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Schrander-van der Meer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthijs","family":"Eefting","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalie","family":"Delfos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cees","family":"van Nieuwkoop","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2011,10,28]]},"reference":[{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.1","first-page":"1219","article-title":"Epstein-Barr virus (EBV) infects T lymphocytes in childhood EBV-associated hemophagocytic syndrome in Taiwan.","volume":"144","author":"Su","year":"1994","journal-title":"Am J Pathol"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S1040-8428(02)00119-1","article-title":"Cell type specific infection of Epstein-Barr virus (EBV) in EBV-associated hemophagocytic lymphohistiocytosis and chronic active EBV infection.","volume":"44","author":"Kasahara","year":"2002","journal-title":"Crit Rev Oncol Hematol"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8588(05)70521-9"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.4","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21564"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.5","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.6","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1200\/JCO.2001.19.10.2665","article-title":"Requirement for etoposide in the treatment of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis.","volume":"19","author":"Imashuku","year":"2001","journal-title":"J Clin Oncol"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.7","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3346\/jkms.2005.20.2.209","article-title":"Successful treatment of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis with HLH-94 protocol.","volume":"20","author":"Lee","year":"2005","journal-title":"J Korean Med Sci"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.8","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1056\/NEJM199112123252402","article-title":"Acute myeloid leukemia in children treated with epipodophyllotoxins for acute lymphoblastic leukemia.","volume":"325","author":"Pui","year":"1991","journal-title":"N Engl J Med"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.9","first-page":"183","article-title":"Longitudinal follow-up of patients with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis.","volume":"89","author":"Imashuku","year":"2004","journal-title":"Haematologica"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.10","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e3181f84a52"},{"key":"2025042708130076000_2011.oct27_1.bcr0820114643.11","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22618"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.08.2011.4643","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T15:13:08Z","timestamp":1745766788000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.08.2011.4643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10,28]]},"references-count":11,"alternative-id":["10.1136\/bcr.08.2011.4643"],"URL":"https:\/\/doi.org\/10.1136\/bcr.08.2011.4643","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2011,10,28]]}}}