title: Significant liver injury with dual positive IgM antibody to Epstein-Barr virus and cytomegalovirus as a puzzling initial manifestation of infectious mononucleosis.
abstract: A 35-year-old man was admitted because of significant hepatic dysfunction with mild splenomegaly and intra-abdominal lymphadenopathy of unknown cause. Infectious mononucleosis was suggested by subsequently detected high fever, pharyngotonsillitis and cervical lymphadenopathy, but IgM to Epstein-Barr virus (EBV) and cytomegalovirus (CMV) showed dual positivity. A definite diagnosis of EBV-induced infectious mononucleosis was established 3 months later on the basis of seroconversion to Epstein-Barr nuclear antigen (EBNA)-IgG positivity and reduced CMV-IgM titer with persistently negative CMV-IgG. This case highlights the initial diagnostic difficulties of EBV-induced infectious mononucleosis particularly in older patients, due to concomitant abnormal humoral immunity and unusual initial manifestations such as significant liver injury and extensive intra-abdominal lymphadenopathy.
authors.affiliation: Department of Internal Medicine, KKR Hokuriku Hospital, Kanazawa.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Zenda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itoh
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takayama
authors.forename: Takaharu
authors.initials: T
authors.lastname: Masunaga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Asaka
authors.forename: Hisanori
authors.initials: H
authors.lastname: Oiwake
authors.forename: Kimihide
authors.initials: K
authors.lastname: Shinozaki
authors.forename: Ryoyu
authors.initials: R
authors.lastname: Takeda
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis*; D003587:Cytomegalovirus / Q000276:immunology*; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology*; D007244:Infectious Mononucleosis / Q000175:diagnosis*; D008107:Liver Diseases / Q000276:immunology / Q000821:virology*; D008297:Male
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M