A Case of Adult Epstein-Barr Virus-Associated Pneumonia with Multiple Cavitary Pulmonary Lesions Confirmed by Lung Biopsy mNGS: A Case Report.

Background: EBV pneumonia with multiple cavitary pulmonary lesions is clinically rare. We analyzed the clinical characteristics, diagnosis and treatment, with an aim to enhance clinicians' awareness of this disease and reduce misdiagnosis and missed diagnoses. Case Presentation: This paper presents A 59-year-old male patient's initial symptoms included fever, cough, sputum, and asthma. The pulmonary CT imaging demonstrated multiple patchy and ground glass consolidation in both lungs, partial cavitary formation, and subpleural mesh lattice changes in the lower lobe of both lungs. Further analysis, including bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) and CT-guided percutaneous lung biopsy mNGS, supported the diagnosis of EBV pneumonia. The patient was treated with acyclovir antiviral therapy for a week, resulting in symptom relief. Follow-up lung CT scans indicated interval reduction of inflammatory lesions, cavities, and interstitial changes. As the patient's condition improved significantly and he was discharged from hospital. The treatment was continued with oral acyclovir for 12 days. Subsequent outpatient follow-up CT performed 12 days after discharge revealed further improvement of the inflammatory lesions, as well as a reduction in cavitary and interstitial changes. Conclusion: The clinical imaging findings in the presented case were highly distinctive and have not been documented in either domestic or international literature. This uniqueness could have potentially contributed to misdiagnosis or overlooked diagnosis. mNGS of percutaneous lung puncture tissue is valuable for the diagnosis of infection with rare lung pathogens.