[CIS PIDD] [cis-pidd] Persitently elevated EBV IgM

[Christian Wysocki]

I don't have an answer but I have a similar patient just referred to me who I have been polling people about as well.  Otherwise healthy 35 year old guy with chronic fatigue who has had positive (albeit low) EBV VCA IgM for 1.5 years now.  Adaptive immune function is otherwise fully inatct (although admittedly I have not looked at CD107a/perforin/SAP/XIAP.....that's one of the questions I have....should I be thinking about sending those?).  No B symptoms, no splenomegaly, no LAD, CXR clear, no cytopenias, negative ESR and CRP.  The only things that have tracked along with his EBV have been CK of 300s and intermittently elevated ALT 50s.  I think his fatigue is med-related, but I can't explain this persistently positive EBV IgM.  And, as in your case, PCR is negative x 2 now.



-Chris



Christian Wysocki MD, PhD
UT Southwestern Medical Center
Department of Internal Medicine
Division of Allergy and Immunology
5323 Harry Hines Boulevard, F4.100B
Dallas, TX 75390-8859
phone: 214-648-8909
fax: 214-648-9102
________________________________
From: Jason Raasch [jraasch at midwestimmunology.com]
Sent: Wednesday, October 09, 2013 3:39 PM
To: CIS-PIDD
Subject: [cis-pidd] Persitently elevated EBV IgM

Appreciate your thoughts/opinions:

In a patient (any age) who's basic immune evaluation for recurrent respiratory illness is unremarkable, how convinced are you that a persistently positive EBV VCA IgM (in the presence of EBV VCA IgG +/- EBNA) indicates chronic EBV infection or carrier status?  What if EBV PCR from peripheral blood is negative?

In other words, in your experience what is the SPECIFICITY of a persistently positive EBV VCA IgM ?  Are there some individuals who just never down-regulate EBV VCA IgM expression?

Thanks for your thoughts.

-Jason



Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N, Ste 110
Plymouth, MN 55446

TEL: (763) 577-0008
FAX: (763) 577-0192

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