SARS-COV-2 AND EBV COINFECTION IN CHILDREN: CASE REPORTS AND DISCUSSION

Coronavirus infection also affects the population aged between birth and 18 years, although in most cases, SARS-CoV-2 infection (COVID-19) in children follows a milder clinical course than in adults. Concurrent viral infections in paediatric patients with COVID-19 are not uncommon. Epstein–Barr virus (EBV), a B-lymphotropic human herpesvirus, typically establishes primary infection early in life. While initial infection is frequently asymptomatic, viral persistence may later manifest clinically as infectious mononucleosis. To date, data describing the clinical features and outcomes of SARS-CoV-2 and EBV coinfection in children remain limited. Purpose: This report describes two pediatric cases of SARS-CoV-2 and EBV coinfection managed at the Department of Pediatrics, “Trakia” Hospital, Stara Zagora, during the COVID-19 pandemic (2020–2021). The first case involved a 5-year-old child presenting with fever and radiographic evidence of atypical pneumonia. The second case concerned a 15-year-old adolescent who initially experienced a mild course of COVID-19 but subsequently, during the convalescent phase, developed clinical signs consistent with infectious mononucleosis, accompanied by hepatitis and pericardial effusion. Material/Methods: Laboratory evaluation in both cases revealed elevated inflammatory markers, including C-reactive protein, D-dimer, and ferritin. Results: Serological testing confirmed dual infection with SARS-CoV-2 and EBV. Both patients received antibiotic therapy, immunomodulatory agents, and supportive symptomatic treatment, resulting in full clinical recovery and normalization of laboratory parameters. Although the clinical course of COVID-19 in children is generally favorable, including in cases of EBV coinfection, EBV may contribute to the development of more severe complications and organ dysfunction, such as multisystem inflammatory syndrome in children (MIS-C). Conclusions: Therefore, in pediatric patients with COVID-19, comprehensive diagnostic evaluation should include serological screening for potential concomitant viral infections, particularly EBV.