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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2025, vol. 31, issue4
Subject Area: Medicine
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DOI: 10.5272/jimab.2025314.6667
Published online: 11 December 2025
Case reports
J of IMAB. 2025 Oct-Dec;31(4):6667-6671
SARS-COV-2 AND EBV COINFECTION IN CHILDREN: CASE REPORTS AND DISCUSSION
Marlena Panayotova1,2
, Valentina Tzaneva1,3,
1) Department of Pediatrics, Trakia Hospital - Stara Zagora, Bulgaria.
2) Department of Pediatrics, Medical Faculty, Trakia University – Stara Zagora, Bulgaria.
3) Department of Infectious Diseases, Epidemiology, Microbiology and Parasitology, Medical Faculty, Trakia University – Stara Zagora, Bulgaria.
ABSTRACT:
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.
Keywords: SARS-CoV-2, EBV, children, pneumonia, mononucleosis,
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Please cite this article as: Panayotova M, Tzaneva V. Sars-Cov-2 and EBV Coinfection in Children: Case Reports and Discussion. J of IMAB. 2025 Oct-Dec;31(4):6667-6671. [Crossref - 10.5272/jimab.2025314.6667]
Correspondence to: Dr. Marlena Panayotova, Department of Pediatrics, Trakia Hospital, Stara Zagora; 1, Dunav Str., Stara Zagora, Bulgaria; E-mail: marlena.panayotova@trakia-uni.bg
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Received: 21 October 2025
Published online: 11 December 2025