Spironolactone was identified as inhibiting a step subsequent to viral DNA replication in EBV, a new mechanism of action. The objective of this study was to describe the adjuvant use of spirololactone in the treatment of active chronic EBV in the Immunology Service of the Hospital das ClĂnicas of the Federal University of Minas Gerais.
We retrospectively reviewed three patients hospital records. Their parents signed the written informed consent for this description.
Patient 1, 10 years old, male. At 7 years, he evolved Hemophagocytic Lymphohistiocytosis (HLH) secondary to EBV (HLHEBV), and was treated with dexamethasone, etoposide, rituximab and human immunoglobulin. Bone marrow transplantation (BMT) was indicated, but no donor was available. Spironolactone was prescribed in june 2018. He persistes with recurrent episodes of fever with oropharyngeal plaques.
Patient 2, 11-year-old male had recurrent fever with the diagnosis of HLHEBV, treated with immunoglobulin and dexamethasone. While waiting BMT, spironolactone has been in used for eight months.
Patient 3, 2 years, male, persistent fever, demonstrated HLHEBV, received intravenous immunoglobulin and dexamethasone, supplemented with etoposide and cyclosporine. Spironolactone was initiated after increased levels of PCR for EBV, despite therapy.
These three cases show that the use of spironolactone in patients with active chronic EBV, still with very variable results between them, requiring longer follow-up time and a longer series of cases for greater definitions. However, it is known that its limited toxicity is one of the most important factors to be considered if promising results occur.