Epstein-Barr virus - Associated adult respiratory distress syndrome in a patient with AIDS: A case report and review

Background: Epstein-Barr virus (EBV) infection has been associated with fat al pneumonitis in immunocompetent patients. We present a case of fatal adul t respiratory distress syndrome caused by EBV infection in a patient with a cquired immunodeficiency syndrome (AIDS), to our knowledge the first such r eported case, along with a survey of archival autopsy cases to assess basel ine expression of EBV in AIDS patients. Design: The case patient's autopsy material was studied exhaustively for infectious agents by culture, histoch emistry, and immunohistochemistry, with negative results. Formalin-fixed pa raffin-embedded lung, spleen, lymph node, and liver tissue were further stu died by in situ hybridization using a probe for EBV early RNA (EBER, Kreate ch). The same method was applied to lymphoid tissues from eight other archi val AIDS autopsy cases. Case patient tissues were also examined by electron microscopy. Results: Strikingly numerous lymphocytes were positive for EBV early RNA in the case patient's spleen, lymph nodes, and hepatic portal ar eas. In addition to positive lymphocytes in the lung, EBV-infected pneumocy tes were also present. Electron microscopy also demonstrated viral material in lymphocytes and pneumocytes. Of the archival cases studied, only one sp leen was found to have rare positive lymphocytes. Conclusion: Primary or re activation EBV infection may represent a previously underreported cause of morbidity and mortality in AIDS patients. Autopsy tissues from AIDS patient s do not routinely show overexpression of EBV early RNA by in situ hybridiz ation, making this technique ideal for assessing the contribution of EBV to terminal events in these patients.