Viruses – Epstein Barr Virus

November 8th, 2010

Epstein Barr Virus (EBV) is a member of the herpes virus family and produces a variety of rashes that I encounter in my The Woodlands dermatology and Conroe dermatology clinics.  EBV infects B lymphocytes and mucosal cells and has can remain latent for a person’s entire life.  95% of all people are infected by their twenties and infection is through contact with oral secretions as the EBV virus is shed in saliva.  In young children, primary infection with EBV is usually asymptomatic but becomes much more severe when a patient is initially infected as an adult resulting in the infectious mononucleosis (“Mono”).  Infectious mononucleosis is characterized by fever, headache, lymphadenopathy (enlarged lymph nodes), splenomegaly (an enlarged spleen), and pharyngitis (sore throat).  Many non-specific skin findings occur in infectious mononucleosis: Forsheimer spots (petechiae on the mucous membranes), morbilliform rash, erythema nodosum, erythema multiforme, urticaria, and occasionally painful genital ulcers.  A rash can also result from the treatment of infectious mononucleosis with synthetic penicillins.  Diagnosis of infectious mononucleosis is through cell blood count showing an absolute lymphocytosis over 50% with atypical lymphocytes called Downey cells as well as a monocytosis.  Liver function tests are usually elevated and a Heterophile antibody is positive.  Oral Hairy Leukoplakia (OHL) is a very characteristic cutaneous finding due to EBV, which appears as a poorly demarcated corrugated white plaque on the outer portion of the tongue.  OHL differs from Candidiasis thrush in that it cannot be scraped off with a tongue depressor.  OHL is only seen in immunosuppressed patients as the EBV is being constantly shed in the oral secretions causing this manifestation.  Thus, patients with OHL need to be tested for HIV.  Treatment of OHL is with oral antivirals or topical tretinoin applied to the plaque daily.  EBV is also a cause of lymphoproliferative disorders especially Hodgkin’s disease.

EBV- Downey Cell