Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Infectious Diseases
Significant Liver Injury with Dual Positive IgM Antibody to Epstein-Barr Virus and Cytomegalovirus as a Puzzling Initial Manifestation of Infectious Mononucleosis
Takahiro ZENDAYuji ITOHYoshihiro TAKAYAMATakaharu MASUNAGASatoshi ASAKAHisanori OIWAKEKimihide SHINOZAKIRyoyu TAKEDA
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JOURNAL OPEN ACCESS

2004 Volume 43 Issue 4 Pages 340-343

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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.

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© 2004 by The Japanese Society of Internal Medicine
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