Abstract
Most primary Ebstein-Barr Virus (EBV) infections are asymptomatic, with up to 35% developing infectious mononucleosis (IM). After the initial primary infection (PI), EBV can undergo lytic replication and cause secondary manifestations like chronic active EBV, autoimmune diseases, or tumorigenesis. We aim to highlight the hematological spectrum of EBV and discuss its management. This is a retrospective case series of five adults (> 20 years) with confirmed EBV infection by quantitative polymerase chain reaction (QPCR) in peripheral blood. Case one showed a delayed PI with EBV in a 37-year-old female with generalized lymphadenopathy and spontaneous resolution. Case two was a complicated PI with severe nasal obstruction requiring steroids. Case three was EBV-induced Natural killer / T cell lymphoma with a complete response to modified SMILE therapy and radiation. Cases four and five demonstrate post-allogeneic hematopoietic stem cell transplant (alloHSCT) scenarios of EBV viremia and role of pre-emptive therapy. EBV infection can mimic lymphomas and should be tested in all adults with fever and lymphadenopathy. Although self-limiting, some EBV PI may need steroids. Early EBV QPCR monitoring can aid in prognostication and diagnosis. Post-alloHSCT EB viremia needs monitoring from four weeks to 12 months, especially with ongoing immunosuppression.