Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2017; 07(01): e5-e7
DOI: 10.1055/s-0036-1597265
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Epstein–Barr Virus-Induced Mononucleosis as an Imitator of Severe Preeclampsia

S. Allison Staley
1   Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Marcela C. Smid
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Sarah K. Dotters-Katz
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Elizabeth M. Stringer
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

15 August 2016

20 October 2016

Publication Date:
10 February 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Background In pregnancy, conditions presenting with hematologic abnormalities, transaminitis, and proteinuria pose diagnostic challenges in pregnancy.

Case We present the case of an 18-year-old woman, G1P0, at 33 weeks' gestation with fever of unknown cause, who developed progressively elevated liver enzymes, proteinuria, and thrombocytopenia, due to Epstein–Barr virus (EBV) infection.

Conclusion Acute infection with EBV should be included in the differential diagnosis of preeclampsia with severe features, particularly in the setting of fever. Supportive treatment and observation may prevent iatrogenic preterm birth.

Keywords

preeclampsia - mononucleosis - preterm birth - maternal - thrombocytopenia

Summary

EBV-induced mononucleosis may imitate signs and symptoms of preeclampsia with severe features and should be considered in the differential diagnosis, particularly in setting of fever.


Teaching Points


1. EBV may imitate preeclampsia with severe features and place women at risk for spontaneous and iatrogenic preterm birth.


2. Expectant management and supportive treatment are preferred in pregnant women with mononucleosis, and this form of management may prevent iatrogenic preterm birth.


3. Active infection with EBV is a contraindication to breastfeeding, but not once the patient is postviral.


 

  • References

  • 1 Sibai BM. Imitators of severe preeclampsia. Obstet Gynecol 2007; 109 (04) 956-966
    CrossrefPubMedGoogle Scholar
  • 2 Odumade OA, Hogquist KA, Balfour Jr HH. Progress and problems in understanding and managing primary Epstein-Barr virus infections. Clin Microbiol Rev 2011; 24 (01) 193-209
    CrossrefPubMedGoogle Scholar
  • 3 Lei PS, Lowichik A, Allen W, Mauch TJ. Acute renal failure: unusual complication of Epstein-Barr virus-induced infectious mononucleosis. Clin Infect Dis 2000; 31 (06) 1519-1524
    CrossrefPubMedGoogle Scholar
  • 4 Mayer HB, Wanke CA, Williams M, Crosson AW, Federman M, Hammer SM. Epstein-Barr virus-induced infectious mononucleosis complicated by acute renal failure: case report and review. Clin Infect Dis 1996; 22 (06) 1009-1018
    CrossrefPubMedGoogle Scholar
  • 5 Eskild A, Bruu AL, Stray-Pedersen B, Jenum P. Epstein-Barr virus infection during pregnancy and the risk of adverse pregnancy outcome. BJOG 2005; 112 (12) 1620-1624
    CrossrefPubMedGoogle Scholar
  • 6 Fleisher G, Bologonese R. Epstein-Barr virus infections in pregnancy: a prospective study. J Pediatr 1984; 104 (03) 374-379
    CrossrefPubMedGoogle Scholar
  • 7 Lamounier JA, Moulin ZS, Xavier CC. Recommendations for breastfeeding during maternal infections [in Portuguese]. J Pediatr (Rio J) 2004; 80 (05) , (Suppl): S181-S188
    CrossrefPubMedGoogle Scholar
  • 8 Habib NA, Daltveit AK, Bergsjø P, Shao J, Oneko O, Lie RT. Maternal HIV status and pregnancy outcomes in northeastern Tanzania: a registry-based study. BJOG 2008; 115 (05) 616-624
    CrossrefPubMedGoogle Scholar