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

[Richard Wasserman]

Why have the EBV serologies been repeated?
Richard Wasserman
Dallas

On Tue, Jun 30, 2015 at 7:10 PM, Juan Carlos Aldave Becerra <
jucapul_84 at hotmail.com> wrote:

> 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, MD
> Allergy and Clinical Immunology
> Edgardo Rebagliati Martins National Hospital
> Lima, Peru
>
>
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-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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