DOI: 10.1093/bjs/znad258.318 ISSN:

1219 A Rare Case of EBV Infection Presenting as Acute Appendicitis with Septic Shock - a Case Report and Review of the Literature

K Westby
  • Surgery

Abstract

18yo male presented to the emergency department (ED) with a 2-week history of progressive lower abdominal pain, weight loss of 8kg & diarrhoea. On examination he looked dehydrated, was tachycardic and had a large, tender, palpable mass in his lower abdomen up to the umbilicus. Blood investigations of note were white cell count (WCC) 29.7 and CRP 187.

Computerized tomography (CT) reported an extremely large abscess occupying the lower abdomen and pelvis resulting in bilateral hydronephrosis and hydroureter. The appendix was not visualised.

On the night of admission, the patient went into septic shock on the ward and was taken to theatre from emergency laparotomy. 4 litres of a large abscess were evacuated, the appendix was identified with an inflamed appearance and an appendicetomy performed.

His post operative course was complicated by an ileus and slow resolving, inter-loop abscesses that required multiple courses of antibiotics and eventual return to theatre for further washout.

During his early admission, EBV serology was recommended by the microbiology team on foot of a positive monospot test. Serology was also positive for EBV. Histopathological results of the appendix and lymph nodes showed EBV associated changes.

Acute appendicitis can be considered a complication of EBV infection with the proposed mechanism being obstruction of the appendiceal lumen due to swollen lymphoid tissue, this most commonly occurs in the acute phase of EBV infection.

In this case it has been shown that EBV and subsequent Infectious mononucleosis can cause acute appendicitis and may be its initial presentation.

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