A case of Epstein-Barr virus presenting as spondyloarthritis
Keywords:Cytomegalovirus, Epstein-Barr virus, Rheumatoid arthritis, Spondyloarthritis
Viral arthritis can be caused by various viruses such as parvovirus, alphavirus, rubella, hepatitis B, C and flavivirus. High titre of antibodies to Epstein-Barr virus (EBV) is present in rheumatoid arthritis (RA) patients. EBV, a member of the herpes virus family, is one among the most common human viruses. Vitamin D deficiency can worsen the prognosis in such patients. Abnormalities in innate and adaptive immune reactions in response to EBV infection were one of the complications observed in RA patients. It was a self-limiting infection with a 90% lifetime prevalence. On the other hand, spondyloarthritis was rarely associated with viral infections. A 35 year old male patient who had a history of TB, admitted through OP, with complaints of intermittent fever, joint pain, pain radiating from back to lower limbs. On investigation, the patient was found to be vitamin D deficient. Differential diagnosis such as TB with reactive arthritis, lymphoma and CMV infection were ruled out. MRI of the spine and pelvis confirmed spondylarthritis. The serology for EBV showed that the EBV IgM levels had increased by two-fold. The on-going inflammatory status was well-managed with NSAIDS, as there was low evidence for antiviral therapy. EBV infection presenting as spondyloarthritis is a very rare presentation and here we are discussing a case of spondylarthritis in a patient with infectious mononucleosis. The patients with fever, polyarthritis, lymphadenopathy and spondylarthritis are to be investigated for EBV infection along with the other cause of polyarthritis.
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