Clinical Review

Epstein-Barr Virus–Induced Adrenal Insufficiency, Cardiac Tamponade, and Pleural Effusions

Case in Point

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Despite the typically mild, benign course of primary Epstein-Barr virus, clinicians must consider the possibility of more serious
presentations, especially in the elderly and those patients
who have complicated chronic illnesses.

The Epstein-Barr virus (EBV) is a common herpesvirus that infects humans worldwide and typically causes a syndrome known as infectious mononucleosis (IM). According to the CDC,1 up to 95% of adults in the United States are infected with EBV by 35 to 40 years of age. Many healthy people become asymptomatic carriers and are the primary reservoirs for human-to-human transmission. Classic symptoms of IM are fever, pharyngitis, malaise, fatigue, and tender cervical lymphadenopathy (and in some cases, the spleen and liver become involved). Symptoms are usually self-limited and seldom fatal.


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