[CIS PIDD] [cis-pidd] Persistently elevated anti-VCA (EBV) IgM

[Juan Carlos Aldave Becerra]

Dear professors,
I would appreciate your expert opinions regarding the following case.Today I evaluated a 8 year-old boy with elevated anti-VCA (EBV) IgM lasting almost 2 years.
I summarize his clinical history:- Age: 8 years.- No history of consanguinity.- No severe infections, no candidiasis, no abscesses.- October 2013: fever, lymphadenopathies, splenomegaly and leukocytosis with lymphocytosis. The clinical features resolved completely over 2 weeks without any complication or sequelae. At that time the only positive diagnostic result was an elevated anti-VCA IgM, which persists high for almost 2 years, as shown below:

 
 
 
   
  16-Oct-13
  11-Mar-14
  13-Jun-14
  14-Jul-14
  13-Oct-14
  29-Jan-15
 
 
  Early Antigen Antibody
  Negative
  Negative
  Negative
  Negative
  127.973
  100.801
 
 
  Anti-VCA IgM
  248.7
  225.6
  141.727
  106.039
  112.309
  140.059
 
 
  Anti-VCA IgG
  255.8
  221.096
  212.37
  121.512
  199.94
  224.182
 
 
  Anti-EBNA IgG
  Negative
  290.723
  268.678
  217.786
  195.96
  307.407
 
- EBV-PCR has not been performed (not available).- IgG, IgA, IgM, liver function tests, B2-microglobulin: within normal values.- Negative IgM to CMV and rubella.- Positive IgG to CMV and rubella.- WBC=10,940; lymphocytes=5,650; neutrophils=4,240; eosinophils=480; CD3+ cells=4,256; CD4=1,713; CD8=2,155; CD19=500/uL.- Inverted CD4:CD8 ratio.- Mild eosinophilia (between 480 and 1280 cells/uL).
The patient looks healthy, the mother denies any current symptom.
Please, I would appreciate your expert insights. My question is if the patient's serologic status can be "normal" or I should look for PIDs with susceptibility to EBV.
Thank you very much.
With my best regards,
Juan

Juan Carlos Aldave, MDAllergy and Clinical ImmunologyEdgardo Rebagliati Martins National HospitalLima, Peru

 		 	   		  
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