Acute Kidney Injury and Viral Myocarditis Secondary to Acute Epstein-Barr Virus Infection

Epstein-Barr virus (EBV) typically causes a self-limiting disease characterized by fever, pharyngitis, and lymphadenopathy. Clinically overt renal and cardiac involvement is rare, and its presentation ranges from subclinical manifestations to severe organ dysfunction. In cases where renal biopsies have been performed, the most common pathology identified is interstitial nephritis. We report a case of a 24-year-old male with a history of recurrent tonsillitis - the most recent episode occurring one month prior - who presented to the Emergency Department with a three-day symptom of asthenia, diffuse abdominal pain, and vomiting. His blood tests showed acute kidney injury (AKI) and elevated natriuretic peptide levels, with negative troponin levels. Viral markers were consistent with primary EBV infection. Renal biopsy revealed moderate acute tubular necrosis, with no glomerular injury. Renal function showed signs of improvement within the initial three days following the initiation of fluid therapy. Given the high index of clinical suspicion, a cardiac MRI was performed, revealing myocarditis. This case underscores the potential for EBV to present with AKI and myocarditis, contributing valuable insights into the diverse clinical manifestations of EBV infection.