LAUSR

In December 2018, more than 1 year before the spread of COVID-19 epidemic in Italy, a 20-year-old Sicilian girl, back from a study period in Spain, presented for persistent fever that lasted for over a week with temperature higher than 39 °C. In the past 3 days, she took Acetaminophen without benefit. She had moved from Sicily to Milan when she was 10 years old; in the previous 6 months, she had lived near Bilbao where she was attending the University. She did not have pets and she did not recently travel outside Europe. She did not smoke cigarettes, drink alcohol, or use illicit drugs. She reported an unprotected sexual intercourse 1 week before the onset of the fever. In the past, she had undergone tonsillectomy when she was 8 years old for recurrent pharyngitis; at that time, laboratory data showed Epstein–Barr virus (EBV) IgG antibody positivity, while EBV-IgM antibodies were negative. At present, she was receiving only oral contraceptives for polycystic ovarian disease. She had no known allergies. In the last few months, on May 2018, she has been admitted to our Department of Infectious Diseases for similar symptoms: persistent fever associated with pancytopenia, reactive lymphocytosis, and abnormally elevated results of liver-function tests. At that time, Hepatitis A virus IgM antibodies, Hepatitis B surface antigen, Hepatitis B virus core IgM antibodies, Hepatitis C antibodies, and Human Immunodeficiency virus (HIV) antibodies were negative; the serology for Epstein–Barr virus, Cytomegalovirus, and Parvovirus B19 was compatible with a previous infection (IgG antibodies resulted positive, while IgM antibodies were negative). Blood and urine cultures were negative; since the patient had lived in Sicily and a close relative was previously diagnosed with visceral Leishmaniosis, serology, and PCR on peripheral blood were performed and were negative. The fever resolved spontaneously after 2 weeks and the patient was discharged with a diagnosis of unspecific viral infection.