Epstein-Barr virus burden in adolescents with systemic lupus erythematosus

Objective. We sought to determine whether patients with systemic lupus eryt hematosus (SLE) and a presumed primary or reactivated Epstein-Barr virus (E BV) serologic response had evidence of an active EBV infection. Background. Patients with SLE often have what appears to be a primary or re activated EBV serologic response. If these patients then present with fever , fatigue, adenopathy or leukopenia, it is not clear whether these symptoms are caused by worsening SLE or EBV infection. Establishing the correct dia gnosis is crucial for management. Methods, We examined the EBV burden in 13 adolescents with SLE and a presum ed primary or reactivated EBV serologic response. All were taking prednison e; 2 each were also on azathioprine or intravenous pulse cyclophosphamide, EBV serologies were performed for all, and EBV burdens were assessed via im mortalization assays and EBV DNA amplification of blood and saliva at least once. Results. Seven patients had serologic patterns indicative of a primary EBV infection, while six had serologies indicative of a reactivated (secondary) EBV infection, Two of the latter were the only ones in whom a small amount of biologically active EBV was detected. Conclusion. In our series active EBV infection was not seen in most patient s, despite serologic data that could be interpreted as a primary or reactiv ated infection. Thus the serologic profiles were more likely a consequence of immune dysregulation secondary to SLE or its therapy rather than rampant infection with EBV.