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- Peter Cosgrove, MBBChBAO*
- Kartik Pillutla, MD†
- *Department of Emergency Medicine, Boston Children’s Hospital, Boston, MA
- †Department of Pediatric Nephrology, Dell Children’s Medical Center, Austin, Texas
AUTHOR DISCLOSURE
Drs Cosgrove and Pillutla have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A 4-year-old girl presented to the emergency department with a 2-day history of fever, poor oral intake, and nasal congestion. Three months prior she received a deceased-donor renal transplant for end-stage renal disease due to diffuse mesangial sclerosis. Prior to transplant she was Epstein-Barr virus (EBV) immunoglobulin G negative. The patient was on standard immunosuppression after her transplant including tacrolimus, mycophenolate mofetil, and prednisone.
In the emergency department she had a low-grade fever and bilateral pharyngeal tonsillar exudates without trismus. She had a positive result on rapid EBV testing and a negative rapid streptococcal test result.
Eight days later she developed worsening shortness of breath, loss of appetite, and lethargy. In the emergency room she was found to be in …
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