多発性脾臓梗塞：急性エプスタインバーウイルス感染症に伴う遺伝性球状細胞症の異常

Multiple splenic infarcts: unusual presentation of hereditary spherocytosis associated with acute Epstein-Barr virus infection.

• Aye Mon Thida
• Ifeanyi Ilonzo
• Pouyan Gohari

抄録

19歳のアフリカ系アメリカ人女性が，吐き気，倦怠感，食欲不振，自覚的発熱，悪寒を伴う左上腹部痛を1週間前から訴えて救急外来に来院した．家族歴は母方の叔母にタラセミア、弟、妹、従兄弟に遺伝性球状細胞症を認めた。腹部と骨盤の造影CTスキャンで巨大な脾腫と多発性脾梗塞を認めた。入院2日目に103°Fの発熱を呈した．さらなる検査で急性エプスタインバーウイルス（EBV）感染と遺伝性球状細胞症が判明した。ピペラシリン/タゾバクタム、点滴、鎮痛剤、解熱剤で4日後に容態は改善した。本症例は、発熱、貧血、巨大な脾腫と多発性脾梗塞を呈した患者の臨床評価を行ったものである。急性EBV感染症に伴うウイルス血清学的検査でIgM陽性が多発した場合の慎重な解釈の必要性を強調している。

A 19-year-old African American woman presented to the emergency department with a history of left upper quadrant pain for a week, associated with nausea, malaise, loss of appetite, subjective fevers and chills. Her family history is significant for thalassemia in her maternal aunt, and hereditary spherocytosis in her brother, sister and cousin. A contrast-enhanced CT scan of the abdomen and pelvis revealed massive splenomegaly and multiple splenic infarcts. On the second day of admission, she developed a fever of 103°F. Further evaluation revealed acute Epstein-Barr virus (EBV) infection and hereditary spherocytosis. Her condition improved after 4 days on piperacillin/tazobactam, intravenous fluids, analgesics and antipyretics. Our case report describes a thorough clinical evaluation of a patient with fever, anaemia, massive splenomegaly and multiple splenic infarcts. It highlights the need for careful interpretation of multiple positive IgM results on viral serological testing that often accompanies acute EBV infections.

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