Severe Thrombocytopenia as a Life-Threatening Complication of Primary Epstein-Barr Virus Infection in a Young Adult: A Case Report.

Abstract

Abstract:

Background:
Epstein–Barr virus (EBV) infection commonly manifests as infectious mononucleosis and is usually benign. However hematologic complications such as immune thrombocytopenia may occur and can be severe. Thrombocytopenia identified in the emergency department requires prompt evaluation to rule out life-threatening conditions including disseminated intravascular coagulation, thrombotic microangiopathy, and purpura fulminans.

Case Report:

A healthy 27-year-old man presented with fever, lumbar pain and dysuria. Initial laboratory testing revealed isolated thrombocytopenia (39 × 10⁹/L) which rapidly deteriorated to < 5 × 10⁹/L within 48 hours. He developed persistent bleeding at a venipuncture site, hemorrhagic oral bullae and purpura. Imaging showed presence of splenomegaly. Peripheral smear showed presence of activated hyperbasophilic lymphocytes. Serologic testing confirmed acute EBV infection. The findings supported a diagnosis of EBV-associated immune thrombocytopenia. The patient was admitted to the intensive care unit due to the high risk of hemorrhage and received intravenous immunoglobulin followed by corticosteroids. Clinical status and platelet counts improved rapidly and patient could be discharged after six days.

Conclusion:
Acute EBV infection should be recognized as a potential cause of severe isolated thrombocytopenia in adults. Early identification can prevent unnecessary invasive investigations and enable timely initiation of immunomodulatory therapy. Although infectious mononucleosis is usually self-limited its hematologic complications, such as severe thrombocytopenia, may be life-threatening.