Epstein–Barr virus-related dacryocystitis: a case report

Journal of Medical Case Reports
J. Sternberg1, Silvia Lambiel2, Hélène Cao Van2, Horace Massa3, Basile Nicolas Landis2
1Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland.
2Department of Clinical Neurosciences, Oto-Rhino-Laryngology and Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
3Department of Clinical Neurosciences, Ophthalmology Unit, Geneva University Hospital, Geneva, Switzerland

Tóm tắt

Abstract Background and objective Acute dacryocystitis is an atypical and rare manifestation of pediatric mononucleosis still widely underdiagnosed in clinical practice. We report this rare condition and describe challenges in its diagnosis and treatment on the basis of a presented case. Case presentation A 6-year-old Caucasian girl without any ophthalmic history was admitted for right preseptal cellulitis requiring intravenous antibiotic therapy. During hospitalization, she developed a fluctuating lump in the nasolacrimal region which resembled an abscess, both clinically and radiologically. There was no spontaneous purulent discharge. Serology was positive for acute mononucleosis and Epstein–Barr virus-related dacryocystitis was diagnosed. Following multidisciplinary discussion, she was treated conservatively with digital lacrimal sac massages and intravenous antibiotic therapy with an excellent outcome. Discussion This rare form of Epstein–Barr virus is poorly documented in the literature, and thus barely known. As initial symptoms are nonspecific (rhinitis, fever, eyelid edema and erythema lack of purulent discharge, and moderate bilateral cervical lymphadenopathy), diagnosis is often difficult. Nevertheless, differentiating between dacryocystitis and abscess is crucial to select the appropriate treatment and avoid unnecessary, potentially harmful surgery. Conservative management of dacryocystitis appears to be the gold standard of treatment. Conclusion Acute dacryocystitis in children free of ophthalmic history should raise suspicion of primary Epstein–Barr virus infection. With conservative treatment, prognosis appears to be excellent; therefore, surgery should be avoided as much as possible.

Từ khóa


Tài liệu tham khảo

Bolis V, Karadedos C, Chiotis I, Chaliasos N, Tsabouri S. Atypical manifestations of Epstein–Barr virus in children: a diagnostic challenge. J Pediatr (Rio J). 2016;92(2):113–21.

Ghauri AJ, Keane PA, Scotcher SM, Clarke JL, Madge SN. Acute dacryocystitis associated with Epstein–Barr virus infection. Orbit. 2011;30(5):245–8.

Infectious mononucleosis. UpToDate. https://www.uptodate.com/contents/infectious-mononucleosis. Accessed 14 January 2021.

Clinical manifestations and treatment of Ebstein-Barr virus infection. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-treatment-of-epstein-barr-virus-infection?search=Clinical%20manifestations%20and%20treatment%20of%20Ebstein-Barr%20virus%20infection&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed 14 January 2021.

Delbet C, Phamdang N, Mondie JM, Barthelemy I. Dacryocystite aiguë sur une primo-infection mononucléosique. Rev Stomatol Chir Maxillofac. 2010;111(5–6):334–6.

Givner LB, Mcgehee D, Taber LH, Stein F, Sumaya CV. Sinusitis, orbital cellulitis and polymicrobial bacteremia in a patient with primary Epstein–Barr virus infection. Pediatr Infect Dis. 1984;3(3):254–6.

Atkinson PL, Ansons AM, Patterson A. Infectious mononucleosis presenting as bilateral acute dacryocystitis. Br J Ophthalmol. 1990;74(12):750.

Marqués Fernández VE, Galindo FA. Acute dacryocystitis retention syndrome due to Epstein–Barr virus. Arch Soc Esp Oftalmol. 2021;96(6):321–5.

Steele RJ, Meyer DR. Nasolacrimal duct obstruction and acute dacryocystitis associated with infectious mononucleosis (Epstein–Barr virus). Am J Ophthalmol. 1993;115(2):265–6.

Pinar-Sueiro S, Sota M, Lerchundi TX, Gibelalde A, Berasategui B, Vilar B, et al. Dacryocystitis: systematic approach to diagnosis and therapy. Curr Infect Dis Rep. 2012;14(2):137–46.

Alaboudi A, Al-Shaikh O, Fatani D, Alsuhaibani AH. Acute dacryocystitis in pediatric patients and frequency of nasolacrimal duct patency. Orbit (London). 2021;40(1):18–23.

Kikkawa DO, Grant W, Heiz W, Ronald T, Martin M. Orbital cellulitis and abscess secondary to dacryocystitis. Arch Ophthalmol. 2002;120:1096–9.

Taylor R, Ashurst J. Dacryocystitis. StatPearls. 2021;Jan.

Lombardi D, Mattavelli D, Accorona R, Turano R, Semeraro F, Bozzola A, et al. Acute dacryocystitis with empyema of the lacrimal sac: is immediate endoscopic dacryocystorhinostomy justified? Otolaryngol Head Neck Surg (United States). 2014;150(6):1071–7.

Cahill KV, Burns JA. Management of acute dacryocystitis in adults. Ophthal Plast Reconstr Surg. 1993;9(1):38–42.

Di Cicco M, Bellino EM, Marabotti A, Luti L, Peroni DG, Baroncelli GI. Acute dacryocystitis with giant lacrimal abscess: a case report. Ital J Pediatr. 2020;46(1):1–4.

Thông tin
Thông tin xuất bản

Journal of Medical Case Reports

Thông tin tác giả