{"id":30060,"date":"2025-03-21T15:01:43","date_gmt":"2025-03-21T12:01:43","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=30060"},"modified":"2025-03-21T16:40:42","modified_gmt":"2025-03-21T13:40:42","slug":"hoagland-isareti","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2025\/03\/21\/hoagland-isareti\/","title":{"rendered":"Epstein-Barr Virusu \u0130nfeksiyonunda Nadir Bir Klinik Bulgu: Hoagland \u0130\u015fareti"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

Epstein-Barr virusu (EBV) infeksiyonu; ate\u015f, farenjit ve a\u011fr\u0131l\u0131 servikal lenfadenopati gibi klinik bulgular\u0131n e\u015flik etti\u011fi bir infeksiyon hastal\u0131\u011f\u0131d\u0131r.\u00a0\u0130ki tarafl\u0131 olarak \u00fcst g\u00f6z kapaklar\u0131nda g\u00f6r\u00fclen a\u011fr\u0131s\u0131z \u015fi\u015flik EBV infeksiyonunda nadir bir bulgudur ve \u201cHoagland i\u015fareti\u201d olarak adland\u0131r\u0131lmaktad\u0131r. \u0130lk olarak 1952\u2019de Robert J. Hoagland taraf\u0131ndan tan\u0131mlanm\u0131\u015ft\u0131r (1). Bu yaz\u0131 EBV infeksiyonu tan\u0131s\u0131 i\u00e7in destekleyici bulgu olarak Hoagland i\u015faretine dikkat \u00e7ekmektedir.<\/p>\n

OLGU<\/h2>\n

Kronik hastal\u0131k \u00f6yk\u00fcs\u00fc olmayan 19 ya\u015f\u0131nda kad\u0131n hasta \u0130nfeksiyon Hastal\u0131klar\u0131 Poliklini\u011fi\u2019ne bir haftad\u0131r devam eden iki tarafl\u0131 \u00fcst g\u00f6z kapa\u011f\u0131 \u015fi\u015fli\u011fi \u015fikayetiyle ba\u015fvurdu. Hastan\u0131n \u00fc\u00e7 g\u00fcnd\u00fcr devam eden ate\u015f y\u00fcksekli\u011fi ve bo\u011faz a\u011fr\u0131s\u0131 mevcuttu. Fizik muayenede iki tarafl\u0131 olarak \u00fcst g\u00f6z kapaklar\u0131nda \u015fi\u015flik, servikal lenfadenopati ve kriptik tonsillit saptand\u0131. Di\u011fer sistem muayenelerinin sonucu ola\u011fand\u0131. Vital bulgular olarak ate\u015f 36.6\u00b0C, nab\u0131z 80 at\u0131m\/dk, tansiyon 110\/70 mmHg ve solunum say\u0131s\u0131 12 \/dk idi.\u00a0 <\/span>Hastan\u0131n tam kan say\u0131m\u0131nda; l\u00f6kosit say\u0131s\u0131 18\u00a0000 \/lt, polimorf n\u00fcveli l\u00f6kosit say\u0131s\u0131 3790 \/lt (%21), lenfosit say\u0131s\u0131 11\u00a0200 \/lt (%62.1) ve monosit say\u0131s\u0131 3000 \/lt (%16.6) olarak saptand\u0131. Biyokimyasal de\u011ferleri ise kreatin 0.6 mg\/dl, \u00fcre 22 mg\/dl, aspartat aminotransferaz (AST) 139 \u00dc\/lt, alanin aminotransferaz (ALT) 254 \u00dc\/lt, C-reaktif protein (CRP) 9.2 mg\/lt idi. Serolojik inceleme olarak; EBV VCA IgM ve IgG, anti-CMV IgM ve IgG, anti-HAV IgM, anti-Hbc IgM, HbsAg, anti-Hbc IgG, anti-HCV ve anti-HIV testleri istendi. EBNA IgG testi hastanede \u00e7al\u0131\u015f\u0131lamad\u0131.<\/p>\n

\"\"<\/a>

Resim 1.<\/strong><\/p><\/div>\n

\"\"<\/a>

Resim 2.<\/strong><\/p><\/div>\n

Hasta g\u00f6z kapaklar\u0131ndaki \u015fi\u015flik nedeniyle G\u00f6z Hastal\u0131klar\u0131 Poliklini\u011fi ve Dermatoloji Poliklini\u011fi ile kons\u00fclte edildi. Dermatoloji Poliklini\u011fi\u2019nde alerjik reaksiyon d\u00fc\u015f\u00fcn\u00fclmedi. G\u00f6z Hastal\u0131klar\u0131 Poliklini\u011fi\u2019ndeki g\u00f6z muayene bulgular\u0131nda \u00fcst g\u00f6z kapa\u011f\u0131nda \u015fi\u015flik saptand\u0131 (Resim 1). \u00d6n ve arka g\u00f6z segment muayene sonu\u00e7lar\u0131 ola\u011fand\u0131. Serolojik incelemede, EBV VCA IgM testi pozitif, EBV IgG testi negatif ve anti-CMV IgM testi negatif sonu\u00e7lanan hastaya akut EBV infeksiyonu tan\u0131s\u0131 kondu ve semptomatik tedavi uyguland\u0131. Hasta 15 g\u00fcn sonra kontrole geldi\u011finde g\u00f6z kapa\u011f\u0131 ve kriptik tonsillit bulgular\u0131n\u0131n geriledi\u011fi saptand\u0131 (Resim 2). Tekrarlanan tam kan say\u0131m\u0131 incelemesinde l\u00f6kosit say\u0131s\u0131 8360 \/lt, polimorf n\u00fcveli l\u00f6kosit say\u0131s\u0131 2800 \/lt (%33), lenfosit say\u0131s\u0131 4860 \/lt (%58.1), monosit say\u0131s\u0131 610 \/lt (%7.3) idi. Biyokimyasal test sonu\u00e7lar\u0131nda ise AST de\u011feri 48 \u00dc\/lt, ALT de\u011feri 83 \u00dc\/lt ve CRP de\u011feri 1.6 mg\/lt olarak saptand\u0131. Klinik ve laboratuvar bulgular\u0131 gerileyen hastaya kontrol \u00f6nerildi.<\/p>\n

\u0130RDELEME<\/h2>\n

\u0130nfeksiy\u00f6z monon\u00fckleoz etkenlerinden biri olan EBV infeksiyonu \u00e7ocuk ve gen\u00e7 eri\u015fkin d\u00f6nemde g\u00f6r\u00fclen bir klinik tablodur. Klinik olarak en s\u0131k kar\u015f\u0131la\u015f\u0131lan bulgular ate\u015f, lenfadenit ve farenjittir. Fizik muayenede nadir g\u00f6r\u00fclen Hoagland bulgusu EBV i\u00e7in \u00f6nemli bir ipucudur ve ilk olarak 1952\u2019de Robert J. Hoagland taraf\u0131ndan olgular\u0131n 1\/3\u2019\u00fcnde saptand\u0131\u011f\u0131 bildirilmi\u015ftir (2). Klinik pratikte bu insidans\u0131n daha d\u00fc\u015f\u00fck oldu\u011fu belirtilmektedir (3).\u00a0 <\/span>Ancak yirmi alt\u0131 hastan\u0131n incelendi\u011fi bir \u00e7al\u0131\u015fmada Hoagland bulgusu 14 hastada saptanm\u0131\u015ft\u0131r (2). Erken fizik muayene bulgular\u0131ndan biri olmas\u0131 nedeniyle olgumuzda oldu\u011fu gibi hastaneye ba\u015fvuru gecikti\u011finden insidans d\u00fc\u015f\u00fck saptanabilir. Ay\u0131r\u0131c\u0131 tan\u0131da monon\u00fckleoz d\u00fc\u015f\u00fcn\u00fcl\u00fcyorsa g\u00f6z bulgular\u0131n\u0131n anamnezde ayr\u0131nt\u0131l\u0131 irdelenmesi insidan\u0131n belirlenmesinde yard\u0131mc\u0131 olabilir. Haogland i\u015faretinin patofizyolojisi tam olarak a\u00e7\u0131klanamam\u0131\u015f olmakla birlikte, nazofarengeal viral replikasyon, lenfoproliferatif hastal\u0131k veya lenfatik dola\u015f\u0131m bozuklu\u011fu ile ili\u015fkili ve erken bir klinik bulgu olmas\u0131 nedeniyle atipik lenfosit say\u0131s\u0131n\u0131n 20\u2019nin alt\u0131nda olabilece\u011fi bildirilmi\u015ftir (4). Olgumuz, Hoagland bulgusu ilk geli\u015fti\u011finde ba\u015fvuru yapmad\u0131\u011f\u0131ndan, ba\u015flang\u0131\u00e7taki lenfosit say\u0131s\u0131 bilinmemektedir;\u00a0 <\/span>ba\u015fvuru an\u0131ndaki lenfosit oran\u0131 ise %62.1 olarak saptand\u0131.<\/p>\n

Hoagland bulgusu genellikle ge\u00e7icidir ve baz\u0131 olgularda iki haftadan daha uzun bir s\u00fcrede kayboldu\u011fu bildirilmi\u015ftir. Hava yolu t\u0131kan\u0131kl\u0131\u011f\u0131 nedeniyle sistemik kortikosteroid kullanan olgularda daha erken kaybolmu\u015ftur (3). Olgumuzun 15. g\u00fcn kontrol\u00fcnde bulgular\u0131n geriledi\u011fi g\u00f6r\u00fcld\u00fc ve steroid tedavisi uygulanmam\u0131\u015ft\u0131.<\/p>\n

\u0130ki tarafl\u0131 g\u00f6z kapa\u011f\u0131 \u015fi\u015fli\u011finin ay\u0131r\u0131c\u0131 tan\u0131s\u0131nda periorbital sel\u00fclit, Kawasaki hastal\u0131\u011f\u0131, alerjik kontakt dermatit, anjio\u00f6dem, tri\u015finozis gibi hastal\u0131klar mevcuttur (4).\u00a0 <\/span>Olgumuzun G\u00f6z Hastal\u0131klar\u0131 ve Dermatoloji polikliniklerinde fizik muayenesi yap\u0131lm\u0131\u015f ve olas\u0131 ay\u0131r\u0131c\u0131 tan\u0131lar d\u00fc\u015f\u00fcn\u00fclmemi\u015fti. Ancak laboratuvar bulgular\u0131nda EBV VCA IgM pozitifli\u011fi olmas\u0131 \u00fczerine EBV virus infeksiyonu tan\u0131s\u0131 konuldu.<\/p>\n

EBV infeksiyonu ate\u015f, lenfadenit, tonsillit gibi bulgularla seyretmektedir ancak Hoagland i\u015fareti EBV infeksiyonunun ilk fizik muayene bulgusu olabilir. Bu nedenle, iki tarafl\u0131 g\u00f6z kapa\u011f\u0131 \u015fi\u015fli\u011fi ile ba\u015fvuran gen\u00e7 hastalarda ay\u0131r\u0131c\u0131 tan\u0131da EBV infeksiyonu d\u00fc\u015f\u00fcn\u00fclmelidir. Olgumuz olgu Hoagland insidans\u0131 a\u00e7\u0131s\u0131ndan yol g\u00f6stericidir ve ay\u0131r\u0131c\u0131 tan\u0131da EBV monon\u00fckleoz tablosuna dikkat \u00e7ekmektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Epstein-Barr virusu (EBV) infeksiyonu; ate\u015f, farenjit ve a\u011fr\u0131l\u0131 servikal lenfadenopati gibi klinik bulgular\u0131n e\u015flik etti\u011fi bir infeksiyon hastal\u0131\u011f\u0131d\u0131r.\u00a0\u0130ki tarafl\u0131 olarak \u00fcst g\u00f6z kapaklar\u0131nda g\u00f6r\u00fclen a\u011fr\u0131s\u0131z \u015fi\u015flik EBV infeksiyonunda nadir bir bulgudur ve \u201cHoagland i\u015fareti\u201d olarak adland\u0131r\u0131lmaktad\u0131r. \u0130lk olarak 1952\u2019de Robert J. Hoagland taraf\u0131ndan tan\u0131mlanm\u0131\u015ft\u0131r (1). Bu yaz\u0131 EBV infeksiyonu tan\u0131s\u0131 i\u00e7in destekleyici bulgu olarak […]<\/p>\n","protected":false},"author":4,"featured_media":30292,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5131],"tags":[6064,6065,3738],"class_list":["post-30060","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-olgu-sunumu","tag-epstein-barr-virusu","tag-hoagland-isareti","tag-infeksiyoz-mononukleoz"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30060","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=30060"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30060\/revisions"}],"predecessor-version":[{"id":30295,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/30060\/revisions\/30295"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/30292"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=30060"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=30060"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=30060"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}