199.2 📚 國考版

199.2.0.1 必背 — IM Triad

  • Fever + pharyngitis + LAP (especially posterior cervical) + splenomegaly (~ 50%)

199.2.0.2 必背 — Lab Clues

  • Atypical lymphocytes (reactive T cells)
  • Monospot (heterophile Ab) + 90%
  • VCA IgM acute, VCA IgG + EBNA IgG past
  • Mild hepatitis common

199.2.0.3 必背 — Amoxicillin Rash

  • 90% rash with amoxicillin in EBV — pathognomonic
  • NOT true penicillin allergy

199.2.0.4 必背 — Contact Sports × 3-4 wk

  • Splenic rupture risk

199.2.0.5 必背 — Cancer Associations

  • Burkitt (endemic Africa, jaw mass)
  • Nasopharyngeal carcinoma (Asia, S China — Taiwan!)
  • Gastric carcinoma (~ 10%)
  • Hodgkin lymphoma (~ 40%)
  • NK/T-cell lymphoma
  • PTLD (post-transplant)
  • Primary CNS lymphoma in HIV
  • HIV-associated B-cell lymphomas

199.2.0.6 必背 — PTLD

  • Risk: EBV-naive recipient + EBV+ donor
  • Reduce immunosuppression + rituximab + EBV-specific T cells

199.2.0.7 必背 — 2022 EBV-MS Association

  • Bjornevik et al. Science 2022
  • Strong evidence EBV may be necessary for MS development
  • Molecular mimicry (EBNA-1 + GlialCAM)

199.2.0.8 必背 — XLP

  • SH2D1A / SAP mutation
  • Fulminant IM + hemophagocytosis + lymphoma

199.2.0.9 必背 — Treatment

  • IM: supportive, no antiviral, no amoxicillin, no contact sports × 3-4 wk
  • Steroid for airway obstruction or severe complications
  • PTLD: rituximab + reduced immunosuppression + EBV-specific T cells
  • CNS lymphoma: ART + methotrexate / whole-brain radiation