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Epstein-Barr virus (EBV) infection can act as a profound physiological stressor in patients with comorbidities, potentially precipitating life-threatening metabolic emergencies. We report a rare case of acute EBV tonsillitis triggering severe diabetic ketoacidosis in a 20-year-old female with type 2 diabetes mellitus (T2DM). The patient presented with severe odynophagia and a drowsy mental status, with laboratory findings revealing critical metabolic acidosis (pH 6.80) and hyperglycemia. Although initially managed for suspected bacterial tonsillitis, serological testing confirmed acute EBV infection. Aggressive fluid resuscitation and intensive insulin therapy stabilized her metabolic state, and aminopenicillins were discontinued pre-emptively without rash development. This case emphasizes that EBV infection can trigger metabolic collapse in T2DM patients. Early diagnosis of EBV in refractory tonsillitis is essential to prioritize metabolic management and avoid unnecessary antibiotic exposure, underscoring the need for clinical vigilance regarding metabolic health during acute viral infections.
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Lee et al. (2026) studied this question.
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