Hillcrest MTC 5/16: CMV, EBV, and False Positive HIV

Today for morning conference, we discussed a very interesting case of a young man who presented with generalized malaise, abdominal pain, and fevers. We were joined by one of our amazing Owen attendings, Dr. Laura Bamford, who helped us work through this case. The patient was found to have hepatosplenomegaly on exam and initial work-up revealed positive CMV IgM, EBV IgM, and rapid HIV test. We did a quick review of CMV and EBV infection in immunocompetent people and discussed the HIV testing algorithm.

  • EBV
    • Aka HHV 4
    • Transmission: Primarily through saliva
    • Presentation: Fever, severe fatigue, exudative pharyngitis, cervical and axillary LAD, and splenomegaly
    • Highly prevalent with almost all adults having serological evidence of prior infection
    • Diagnosis: Typically a clinical diagnosis based on presentation and exposure risks. Atypical lymphocytosis, elevated transaminases and EBV IgM to viral capsid antigen can also help with diagnosis.
      • Monospot to heterophile antibodies is cheap and quick, but it isn’t routinely recommended by the CDC because the antibodies detected can be caused by conditions other than EBV infection
  • CMV
    • Aka HHV 5
    • Transmission: Saliva, blood, transplant, placenta, and breastfeeding
    • Presentation: Most healthy, immunocompetent people have no symptoms, but it otherwise can have a very broad range of clinical manifestations including colitis.
    • 60-90% of adults have latent CMV infections
    • Diagnosis: Serological assays have limited utility because most adults are seropositive. Diagnosis can be confirmed with molecular tests, biopsy revealing classic “owl’s-eye” intracellular inclusions, or by CMV immunostaining.

The patient improved with supportive treatment and was thought to have a false positive rapid HIV test. Thank you so much to Dr. Bamford for joining us today!

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