Acute Ebv Infection and HIV Antibody Cross‐Reactivity

1Yale School of Medicine, New Haven, CT

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 470

Case Presentation:

A 22‐year‐old sexually active female college student without chronic medical comorbidity presented with two weeks of fever, sore throat, malaise and fatigue. She subsequently developed jaundice and sought further evaluation. On admission, examination revealed a low‐grade temperature of 100.1°F. She was nontoxic‐appearing, without rash, oral lesions or significant lymphadenopathy. She was jaundiced, with scleral and sublingual icterus. No hepatomegaly or splenomegaly was present. Admission testing is as summarized in Table 1.

Discussion:

This patient's diagnosis is acute infectious mononucleosis. Sore throat and malaise or fatigue are the most commonly encountered symptoms in this clinical syndrome. Marked atypical lymphocytosis is common, the presence of which (in quantity greater than 10%) has a sensitivity of 75% and specificity of 92% for the diagnosis of infectious mononucleosis. Heterophile antibody testing has a specificity of nearly 100%, though case reports of false positives (most notably in acute HIV infection) exist. The patient's Epstein–Barr virus (EBV)–specific antibody pattern is consistent with an acute EBV infection. Cholestatic jaundice is uncommon and is estimated to be present in fewer than 10% of cases. Important entities in the differential diagnosis of a mononucleosis‐like syndrome include HIV, cytomegalovirus, human herpesvirus 6 and toxoplasmosis. The positive HIV antibody test was presumed to reflect cross‐reactivity in the setting of acute EBV infection, as confirmed by a negative quantitative HIV polymerase chain reaction (PCR) assay the following day. The patient was reassured that she did not have HIV, was discharged from the hospital, and made a complete recovery.

Conclusions:

(1) The diagnosis of infectious mononucleosis in young adults can regularly be made on the basis of clinical presentation, atypical lymphocytosis and a positive heterophile antibody test. (2) Acute HIV infection is an important diagnostic alternative, with quantitative HIV PCR as the suggested screening method in appropriate individuals.

Table 1.Admission Laboratory Testing



Test Result
Total/direct bilirubin 6.16/4.56 mg/dL
Aspartate aminotransferase/alanine aminotransferase 109/108 U/L
Right upper quadrant ultrasound Nonspecific periportal and pancreatic adenopathy
Atypical lymphocytes/absolute lymphocyte count 60%/16,600 cells/μL
Heterophile antibody (monospot) Positive
EBV viral capsid antigen (VCA) antibody Positive (IgM and IgG)
EBV nuclear antigen (EBNA) antibody Negative (IgG)
HIV-1 and HIV-2 antibody Positive

To cite this abstract:

Sankey C. Acute Ebv Infection and HIV Antibody Cross‐Reactivity. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 470. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/acute-ebv-infection-and-hiv-antibody-crossreactivity/. Accessed November 12, 2019.

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