Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV) Coinfection Causes Infectious Mononucleosis

Abstract

This report presents a case of infectious mononucleosis (IM) caused by coinfection of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV).　A previously healthy 3-year-old girl was admitted to our hospital due to frequent vomiting for 14 days and fever for 2 days.　Physical examination showed bilateral cervical lymphadenopathy and hepatosplenomegaly.　Laboratory values were abnormal, including a white blood cell count of 36,560/μL, lymphocytes 43.5%， atypical lymphocytes 23%， aspartate aminotransferase (AST) 1,474 IU/L, alanin aminotransferase (ALT) 1,673 IU/L.　IgM antibodies to EBV VCA and CMV were positive.　PCR assays detected both EBV and CMV.　She was diagnosed as IM with both EBV and CMV.　Although the levels of AST (2,545 IU/L) and ALT (2,395 IU/L) were markedly elevated, they became normal at the 2-month follow-up without antiviral agents.　A limited number of studies have reported on EBV and CMV coinfection in healthy children detected by PCR assays.　Further investigations and case series would be required to establish the clinical entity of EBV and CMV coinfection.