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Domino effect in a patient with Epstein-Barr Virus infection and autoimmunity: A case report

Margarite Matossian, Carrie Crook, Alec Goldberg, Anna Stathopoulos, Justin Tien, Sheela Sheth, Osaid Saqqa & Christopher Dale Shamburger

The link between autoimmune diseases and viral infections has been characterized, but specific mechanisms behind this association remain a current area of investigation. Whether viral infections trigger or unmask autoimmunity, or if the pathologies occur concurrently, is not yet completely understood. Specifically, Epstein - Barr virus (EBV) is implicated in several autoimmune disorders, including Systemic Lupus Erythematosus (SLE). It is hypothesized that common immunologic pathways are activated in the two pathologic states. This case report is an example of this confusing presentation, and the importance of recognizing the association between autoimmunity and viral infections. This patient presented with symptoms concerning for SLE and hepatic autoimmunity with serology suggesting a recent infection with EBV. Given this complicated presentation, it is difficult to determine which disease state presented first in patients with evidence of both SLE and EBV infection and whether this information is clinically relevant for ongoing treatment and monitoring. Here, we provide an in-depth discussion of current genomic and immunological research that supports the associations amongst these disease pathologies.