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Symptomatic Mitigation of a Rare Case of Chronic Active Epstein-Barr Virus (CAEBV)Disease Using Lymphatic Osteopathic Manipulative Treatment

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 14-15. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/10/493538/LBORC-NUFA-Poster-Abstracts-2023-Residents)

Keywords:

case report [514]
Epstein-Barr virus [1]
female [379]
immune system [40]
lymphatic system [40]
OMT [2951]
osteopathic manipulative treatment [2973]
women [333]

Abstract:

Introduction: Chronic active Epstein-Barr virus (CAEBV) disease is defined as elevated EBV infection in the bloodstream as well as tissue infiltration, lasting for greater than 6 months, in the context of immunocompetency. CAEBV has been shown to involve the central nervous system in the first case ever autopsied, with MRI showing multiple abnormal intensity areas in the brain and spinal cord. Case Presentation: A 32-year-old immunocompetent female with a 15-year history of neck and back pain, fatigue, sore throat, earaches, lightheadedness, and chronic sinus pressure presents for a neuromuscular specialty (NMM) consultation. Her symptoms have been worsening despite physical therapy and naturopathic approaches. Cranial MRI 14 years ago displayed concern for demyelination. Her neurological examination has been unremarkable without myelopathy. The lymphatic system, responsible for excreting wastes and toxins, impacts the immune system significantly. Chapman point release for the middle ear, oropharynx, sinuses, cerebellum, cerebrum, neck, and lungs, thoracic inlet release, craniosacral therapy, and re-doming of the diaphragm were employed to decrease sympathetic tone, increase myofascial motion, and improve lymphatic return to areas of visceral pathology. Results: The patient reported amelioration of thoracolumbar and cervical stiffness and resolution of ear, nose, and throat symptoms, as well as lightheadedness, post 3 NMM treatment visits spaced 4 weeks apart. Discussion: Lymphatic manipulation techniques were able to effectively improve CAEBV symptoms. Further research is needed to elucidate the role of mononucleosis on nervous system and autonomic dysfunctions. The mechanisms of EBV reactivation should be explored further to shed light on novel antiviral therapies. Our case is limited by confounding factors such as the patient’s previous caesarian section and cholecystectomy yielding surgical scars and adhesions resulting in neuro-myofascial changes, and her anxiety altering symptomatic perception.


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