Significant liver injury with dual positive IgM antibody to Epstein-Barr virus and cytomegalovirus as a puzzling initial manifestation of infectious mononucleosis.
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.
Zenda
Takahiro
T
Department of Internal Medicine, KKR Hokuriku Hospital, Kanazawa.
Itoh
Yuji
Y
Takayama
Yoshihiro
Y
Masunaga
Takaharu
T
Asaka
Satoshi
S
Oiwake
Hisanori
H
Shinozaki
Kimihide
K
Takeda
Ryoyu
R
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
D000914:Antibodies, Viral; D007075:Immunoglobulin M