Divergent Outcomes in Two Pediatric Cases of Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis

Authors

• Zhang Kai-jing, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, ChinaFollow
• Li Ran, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
• You Deng-xia, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
• Li Yinjie, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
• Qin Tian-tian, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
• Liang Xiao-jing, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
• Huang Jing, Attending physician, Department Hematology of Hangzhou Children's Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China

Abstract

This study retrospectively analyzed the clinical data of two 19-month-old children diagnosed with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) who received treatment with a dexamethasone combined with etoposide (VP-16) regimen. Both children met the early remission criteria for body temperature, IL-10, and IFN-γ within 48-72 hours after treatment initiation, but their clinical outcomes were markedly different. In Case 1, the EBV-DNA load decreased significantly during the initial treatment phase, and platelet counts steadily increased after treatment; the patient had a favorable prognosis at the 2-year follow-up. In Case 2, the EBV-DNA load did not decrease but instead increased during the initial treatment phase, platelet counts remained at extremely low levels with a poor response to treatment, and the patient died due to disease recurrence approximately 70 days after treatment. The comparative analysis of the two cases suggests that the viral kinetics of EBV-DNA load before and after treatment and the speed of platelet recovery may more accurately reflect the body's viral control capability and immune reconstitution status than traditional static risk factors and short-term inflammatory indicators, holding significant clinical value for the early efficacy evaluation and prognosis assessment of EBV-HLH. For children with poor initial treatment response, increasing viral load, and persistently low platelet counts, there should be high vigilance for early recurrence risk and timely adjustment of treatment strategies.

Recommended Citation

Kai-jing, Zhang; Ran, Li; Deng-xia, You; Yinjie, Li; Tian-tian, Qin; Xiao-jing, Liang; and Jing, Huang (2026) "Divergent Outcomes in Two Pediatric Cases of Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis," Journal of Pediatric Infectious Diseases: Vol. 21: Iss. 4, Article 4.
DOI: https://doi.org/10.53391/1305-7707.1077
Available at: https://jpid.researchcommons.org/journal/vol21/iss4/4